HomeMy WebLinkAboutSFPR-09-2022-42249.tif ( 1 ENVIRONMENTAL HEALTH
Catawba Csuly Gwenmest Center
25 Government Drive P.O.flex 389 i Hewta,NC 2865$
Catawba county Plreis: (828)465-3270 Fox:(828)4654276
public health
Email:EHAdmin@CatawbatountyNC.gov
Food Establishment Plan Review Application for Ownership Change
(Note:If the establishment has been dosed for more than one year,then applicant must fill out
short form Instead of this form)
Name of Existing Establishment c('c4-4-iC'S (Car - �Ve
Name of New Establishment: SOU+-6 M a(A Pi 27 tr'i a
Establishment's Address: ,b2 S M A In rove
MQi c c n State: N C ZIP: ' 2 PG. o
mi. -7 b4- 2.00- 1f 08 •
New Owner's Name: 11ea4,c r 14Any nlar d...-.
Please Enclose the Following Docum nts
• Proposed menu items(including seasonal variations in the menu).
• Manufacturer specification sheets for each piece of equipment that may be added or replaced.
• Plan of facility drawn to scale(min'/•"■1')showing location of equipment,plumbing,
electrical service and mechanical ventilation,including location of all electrical panels only if
complete remodel and/or replacing,addinghnoving equipment.That will be determined by
plan reviewer.
•
Hours of Operation Number of Seats: a0O
Si. II qm- qr. Maximum Number of Staff per Shift: IS
•
Moe 11Qrn- Facility Total Sgwre Feet: y.tauu
Toe nom - qfM
Wed I\am- Cirri Projected Start Date: Oc+• 1944' 2022
Tbr I)urn- CrM .
Fri I am- I D Pry Projected Number of Meals to be Served(Approximate somber):
,Sat I)urn- lafrA Breakfast (6 Lunch 35- Dinner '1S
..._ g; i i
, _,
e ..... k
qi
a.
. 4t I
1.' e
o• .4, tee`''
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41
Type41,
of Service ro e
Syr e.
(tbedt all that apply)
who DOOZ :e
&Sit Dom Meals ❑Push Cori
G���•ar
r
Take Oat ❑limited Food Service k$'o
❑ Caterer ❑Single Service Utensil Only
❑ Mobile Food Unit 0 Multi-Use Utensil Service Only
0 Other
Items that Need to be Addressed
1. Information plans should include;the proposed mean,seating capacity,projected day r:e f;vol:vme for food service
operation.
\
2. Adequate rapid cooling including ice baths and refrigeration,and hot-holding facilities for potentially hazardous food
(PHF)should be dearly designated on the plan.
3. When menu dictates,separate food preparation sinks should be labeled and located to preclude contamination and •
cross-contamination of raw and ready to eat foods.
4. Auxiliary areas such as storage rooms,garbage rooms,toilets,basements and/or
preparation should be represented on a plan. cellars used for storage or food ?f�
5. Insure that all food service/kitchen equipment is National Sanitation Foundation International(NSF)listed,
Underwriters Laboratories Inc.,Classified for Sanitation or if not NSF or UL listed/dassified,be constructed to meet l
NSF/ANSI standards as specified according to ISA NM18A.2600,Role.2654 and 2009 NC Food Code Manual '
Chapter 4. `
6. As specified according to 2009 NC Food Code Manual 4-4 allItems stored is rooms where food or single-service items
are stored shall be at least 6 In.(15.24 cm.)above the floor when placed on stationary storage units or when placed �}
on portable storage units or otherwise arranged so as to permit thorough cleaning. `'
Existing Finish Schedule
`
Floor,wall and ceiling finishes lvingl tile,acoustic tile,vinyl baseboards,,FRP,etc.)
Floor Base Walls Ceiling .
Kitchen
Bar ► le FQ• .MIN4i i •
NA NA FRP '
Food Storage
--ri t .
Dry Storage it. R P _ Y
Rastr000s 'Tile Pair+i *.
Garbage IL Can Wash Areas ' '
• Ce,esre+e �e "
Wait Station Arens -rug__ 1n4 —� ,j
Other ,Other / • �•
1 )
. .
4- 1.
Food Preparation Review
Check categories of Potentially Hazardous Food(PHF)to be handled prepared and served.
Category
g'S(es ❑No Thin meats,poultry,fish,eggs(hamburgers,chicken breast,fish filet,etc.)
'Yes ❑ No Thick meats,whole poultry(whole roasts,pork,chicken,meat loaf,etc.)
Ens ❑No Hot processed foods(soups,stews,chowders,casseroles)
❑Yes �No Bakery goods(pies,custards,creams)
Other.
Supplies & Storage
Food Supplies
Are all food supplies from inspected and approved sources? AYes nNo
Cold Storage
Are adequate and approved freezer and refrii3a;o'iefa icy stare hazel foods at 00 F and below,and refrigerated foods at 450 F
(700C)and below?[Yes nNo 1 /+ � �J
Provide the method used to calculate cold storage regeiresaests: 6'O•}�11.rtrt T 4- re ttigug�lor 4,tr(i rl 4crJ
Space dedicated to walk-ia cold storage: I x ? ft2 Space dedicated to reach-in cold storage: S x •1 ft2
Will raw meats,poultry and seafood be stored In the 11same refrigerators or freezers with cooked/ready-to-eat foods? 1Yes nNo
If yes,bow will cross-contamination be prevented? H t it A rc u j 5u I ri s h n•es , des;1 r14C Cif S-kraTe <',r c 41
Does each refrigerator/freezer have a thermometer? VI Yes I I No
Number of refrigeration units: 's Number of freezer units: 2.
L
Thawing
Please indicate by checking the appropriate box how PHF(potentially hazardous food)In each
category will be thawed.More than one method may apply.
Thawing Process Thick Meats Thin Meats Fish Seafood Poultry Products Baked Goods
Refrigeration
Running Water less than 700 F(210 C) C-a ❑ L
Cooked frozen(indicate wt.lbs.) _ ;c, ' L.3•
Microwave
Other(describe):
4 F
e
.,p i ,
Cooking Process
Will food product thermometers(0°—212°F)be used to measure final cooking/rebeatiag temperatures of PHF(potaatially horn 4 CL:c
LIYes ❑ No
A.
Minimum cooking time and temperature of product utilizing convection and conduction heating
equipment:
Product Time&Temperature ProducE Time&Temperature
Beef roast 130�F(121 mini (ommltta?d(.:err%, 155' F(15 sec)
Seafood 145°F(IS sec .. _.._
P07f 155°F(15 sac Pc�:,Eta_,--_ 16S°F(IS sec)
) Qth.t, Nil 145°F 15 sec E s 145a F 15 sec *rebeatin f'}ii llii ' '
Hot Holding
How will hot PHF(potentially hazardous food)be maintained of 1350 F(570 C)or above during bolding for service? ledicate type and
A.
uunsber of hot holding units. �.
ea l A.h
e
d 1 G 1 . •
Cold Holding '
How will cold PHF(potentially hazardous food)be maintained at 450 F(70 C)or below during holding for service? Indicate type aid ..t
samba of cold holding units.
LJw11- ;n rt Pr II 44:or. ma' CA r�a�t 4S' •� �1.�
`ti.
Inver -).0 river c4tirn.$ • Cooke -1-fverrworne i-r,1 4. (�•
)ant tia4.Lc.1 io f{,r�rr,s 1'nr :�.
I
f.
Cooling
Pleas.indicate by checking the appropriate box how PHF(potealaly hazardous food)wi be cooled to 450 F(70 C)within 6 hours(1350 F
to 700 F In 2 hours and 700 F to 450 F lit 4 hours).
Cooling Process Tick Meats Thin Meats Fish Seafood Poultry Product' Baked Good'
r
Shallow Pau
ice Baits '� 'p _I 1 ❑ -k
Rapid and _ - 0 0Ai__
oth.r(describe): COC21' } raCki /�
�[+ Id�� S�t� �L1.�c s (� te14))L t< f'�G 1'ti r r�r
r ,l• r.ti i 9f."
itt
. k - �a_ts . b 'S. "�. s: /. < i a" -. ._�r`i t''� er _ L! .-. - 3•L
ry
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Food Preparation
Please list categories of food prepared more than 12 hours in advance of service.
. i dm)s - r it Itn , haz .4 .4-Ivau 1prooC w4(14.
* e
• fir.r — mc_rn"(As faA4
• Pas I nonslisi
Will disposable gloves and/or utensils and/or food grade paper be used to minimize handling of ready-to-eat foods?'Yes ❑ No
Is there as established polity to exclude or restrict food workers who are sick or hove Infected cuts and lesions?Mes ❑ No
Please describe procedure: �+ I n
QwTarw. mrrnbtr tw?� Pevtr , c�ia r r into in F-ic 41.0 WI1 , 1-t II 4", iat,f1c•<<cc
(.xik l,t Sn A - ko(,nt 1L%4 Mtmitt, n( nnana -en,tn4• J
1`rawe tm6tri are /� a.cktd +o Call -I+ r[sfeurv�.•d tr. -•i-L t'n,t encc
ho t any Of.' c-Sovc (L c)-ed cp.r6rn •
How will cooking equipment,cutting boards, rots?or taus end other food contact surfaces which cannot be submerged is sinks-Or pat- '
throegh a dishwasher be cleaned and saaitizeer1 Pknssn Miele procedure:
"f' ►fk . d'%k sti• of 1 I•c...f.r
How will ingredients for cold ready-to-eat(cods such as tuna,mayonnaise and eggs for salads and sandwiches be pre-chilled before mixed'
and/or assembled? • 11-- rr _
Iw3i ll bt Ltr 4 1 n is M s tr can Un i fv Anse Q111� D A-t a -i•o! .,
t Ih tits O(-r1 tr
Indicate any specialized process that will take place: •
❑Curing ❑Acidification(sushi,etc.) ❑ Smoking .v r • ,
❑Reduced Oxygen Packaging(e.g.vacuem packaging,sous vide,cook-chill,etc.)•
Explain checked processes: • . .(rW .!, ci g d•>b'1 r:'. t.• .
•
4
f' +,'� =v/ ' 't � i Q: ►+ ► . . t .- ! w'r1r- ` , `- 4�
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Food Preparation Procedures for Facilities i •e
'1t,/ .% 40> ,- a ra'�
.CO � + ,/' Food preparation procedures are needed to obtain information on how the food is prepared and �.e• \
help determine that adequate facilities are available. T1N food preparation procedures should include types of food prepared,time of day and equipment used for service in the facility. 4
/4 (Attached is Food Item Preparation Worksheet Supplement for additional food items prepared 1n
�j 6 the facility.)If your company has food preparation procedures already developed,these can be
I submitted as part of the plan review approval process.
..y
Produce Preparation Procedures
Vial produce le wasted ar rinsed prior to ma?
..'.`c Is here en apprewd location used for woshieg or rinsing produce?
Wes L °ie
U. Wil if' #r,. W used fer ether eperatieu? 1 5..1.c1 i 3- ., 0 Ya �Ne _ .
e i ax
Nose Inrush bcatioe aiproduce woshi pr
yr'ii � eg equipineel and desm'be:tbe pfoeederes. lnduda time of day and frequary for washing ar.
J riesieg tie products at this location:
{ ' N{ . 4 Qre
'l V�r r.IrVr,y T k fn ?re Ari'G• PR�r�.s[r will Le
+ Please describe tie produce preparot'ron procedures sad lodicotelocafion of bi meat to su
� P pporl 11cis opeatioe. lie preparation - . ."
.1161, 014,w procedure should include dishes(proposed nun Items)I.which tie produce will be used,aid should iedude time of da
la'rftely and frequency
•a of preparation for tie produce at this location:
fn 4jit_ t.1ntdreI or rid 1eors nisi;,p, In. -1-4vc ch Sn
`, Seafood Preparation Procedures • 4 • •_.
Will seafood be washed or rinsed prior to use? 0 Yeso
is there on opproved location used for washing or rinsing seafood? 0 Yes []No I". 1 ,
' Will it be used for other operations? ❑Yes No
1. ' . Please Indicate location of seafood washing equipment and describe the procedures. include lime of day and frequency for washing or
+k rinsing the seafood at this location: 1
NA - 1h ru
� rtc, to Ptolan 1 if 4g4+tJ rh W.11_ it. F4crtk -.lc,
4ec rig Aiacad- rp.c,k
c '
Please describe the seafood preporaHon procedures and Indicate location of equlpmeut to support this operation. Tie preparation r
procedure should include dishes(proposed eaeu items)In will the seafood will be used,and should hdude time of day cud frequency
' .J of preparutiou for tie seafood at this location:
4.0 ,
• y • , `
' fy
014P1' 'r.
'S100►
O'OIA
20
Poultry Preparation Procedures
Wulf poultry be washed or rinsed prior to use? ❑ Yes Rio
` Is Ibere as approved location used for washing or rioting poultry? ❑Yes ❑No
Will It be used for other operations? ❑Yes ❑No
Please iedkote location of poultry wa;ltia j equipment aid describe the procedures. Include time of day and frequency for washing or
closing Al seafood at this location: 1 �t�o
C4rtts r. t`.ssll �al, .ssr>t .1-4f*., (cake., 1c -1Pn,f re
Please describe tiro poultry preparation procedaras and Iodlcate koalas of equipment to support this operation. The preparation
procedure should include dishes(proposed menu items)in wilds the poultry mil be used,and should include time of day aid
frequency of preparation for the poultry at this location: �+
4Lawcsp in WAlk (r re Pr,tic•{-or . Nowt j to Iire r<s.p l .
Pave Ls•Q la:d i Oak. ief tr i e` tdn�tr s: �• "(Amm iri e�t'i�.irn 12
On Vl•4- .1,2( sc11+
Pork and/or Red Meat Preparation Procedures
Win pork aid red moots be washed or rinsed prior to am? 0 Yes glio
Is there an approved location used for washing or rinsing pork and rod moats? ❑Yes ❑No
WMA it he used for other operations? ❑Yes ❑No
Please indicate location of seafood washing equipment oil describe the procedures. include limo of day and frequency for washing or
rinsing tie seafood at this location:
0%tryr•a arc 4-11e orl,i It J mm..� fomtl i. 1c_rj wc.c S4Jr
rt.-Ann , , it t ur Q.' q1(a.t in Q'.l.l �'�;.a cNijifwe�+.l rare... . .nn�.�
f�9f i•mac r<.. ,f% r I J c c ( 1- CAI 11.u1 �e --l-e -t-'1,J• 4o f
Please desalts the pods aid red meats preparation procedures and indicate location of equipment to support this operation. The
preparation procedure should include dishes(proposed menu Items)is witch the park and red meats will he used,aid should include
timer of day end fregoncy of preparation for tiro pork end red meats at this location:
,]ar t QS clove
Design Information ,
Dry Goods Storage ` �ti.
Is appropriate dry good storage space provided for based upon menu,meals and frequency of deliveries? ®'Yes 0 No
Provide information on the frequency of deliveries and the expected gross volume that Is too1__be delivered each time.
(a olt Iturr i4 s it Litt t' . 5,t oo or€ br.s 741-..1
tS4ortlt fYorf.,cl.
Water Supply
Water supply: ❑ Well(community) [Municipal
If the water supply is other than a Municipal supply,it will be required to be registered with Publir Wilier Supply.
If water supply is from a Community Water Supply system is it registered and approved as public water supply? tithes ❑No
Yes If yes,please attach copy of written approval and/or permit.
Ice: l_J Made on premises ❑Purchased commercially
If made on premises,thee specification for the ice machine will need to be provided.
Ott ``
Describe provision for ice scoop storage:
J'Coos tt ittrE in a Gn (6_ide af I'Ce Aft&C.; A, t4.s-e1p
Garbage and Recyclables
Will a dumpster be used? girYes ❑No
Number of Dempster': She: Pickup frequeucy: I k f er �t{k
Will the dumpster be cleaned on site? 'Yes ❑No
If the dumpster is to be cleaned on site;then the waster water-from the cleaning operation will be required to bilischerged to the ; r;
sanitary sewer system. ' ' ''�". •
,
Is the dumpster to be cleaned by an off site contracted cleaning service? ❑Yes Vito
If yes,please provide name and address of the firm contracted for this service.
Name:
Mailing Address:
City: State: Zip Code:
Telephone: Fax:
i�
i
/ ,
y I bast
wi containers be stored outside? Yes ❑No
I(ySs,please describe location: l, 1 f
/ �p r. ftJC +{ ,—t 71 Ash. L•n imp will bt 0011,dc y`r 44-t racici
/ i.1_1 is ir_< s( _rf1u -l-1. - t&lr nter,:i re i..c r" 414. ir 4c k
Recycling
iType of waste canting greoe s* rcge receptacle: Cl^t 411 'fry - Va.Ilt.,i pw h 1^1
Location of waste coo 4 g pima storage race itade: OV bite/4 - 1`tk Pc4t'nr (Of
Is there an area to store recycled containers? 2ts ❑No
She of grease trap: L
Location of grease trap: t)C.C.l (ca-ki ! foi
Sewage Disposal
Is handing cosaeded to a municipal sewer? I9Yes ❑No
If no,is private disposal system approved(septic system)? ❑Yes 0 No ❑ Pending
If yes,please attach a copy of the written approval and/or permit.
I hereby certify that the above information Is correct, and I fully understand that any deviation
from the above thout prior ap viol from this Health Regulatory Office may nnilify this
approval. n A q
Signature: try\s� Date: _J. / `, c20aa
Owner or Resptide Representative
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(1 THE ESSENCE OF COOKING , I
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Conveyor Oven
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Models: C2000, C2600
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o Installation and Operating Manual
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c AWARNING AADVERTENCIA, .- 1AAVERTISSEMENT —
Do not operate this equi ment unlessyou No o re este a ul o al manorsquo haya Ne
f p pe q p y pas utiliser cot equipement sans avolr
E have read and understood the contents of leldo y comprendido el contenido de este lu et compris le contenu de ce manual I
C• this manual! Failure to follow the manual!Cualqulerfella en el seguimiento Le non-respect des Instructions
f Instructions contained In this manual may de las Instrucciones contenldas en este contenues dans ce manuel pout entralner
C result In serious Injury or death. This manual puede resuitar en un serio lesion de graves blessures ou la mort. Ce
C manual contains Important safety o muerte. Este manual contiene manual contlent des Informations
Information concerning the maintenance, importante InformaclSn sobre aeguridad importantes concemant I'entretien,
G use, and operation of this product. If concemiente al mantenimlento, use y I'utlllsatlon et le fonctionnement de ce
C you're unable to understand the contents operacibn de este producto.SI usted no prodult. SI vous ne comprenez pas le
of this manual, please bring It to the puede entender el contenldo de este contenu de ce manuel,veuillez le signaler
C attention of your supervisor. Keep this manual por favor pregunte a su a votre super-lour.Conservez ce manuel
t 1 manual In a safe location for future supervisor. Almacenar este manual en dans un endrolt ear
pe pour pouvolr vous y
f I, reference. una locallzaclon segura pare la referencia starer plus Lard.
t future.
f
C PN 07.04.673.00 O 2016 Ovention,Inc.
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L DESCRIPTION
odels Model C2600
/ilityinboth
tion•Conveyor Ovens are designed to provide unequaled Model C2600 has three different conveyor oven
kitchen and frontf-the-house installations. configutionsingle belt,50/50 split belt,and 70/30 split belt.
uperior cooking control,small footprint,low heat escape, The split belt models allow two different cook durations (belt
ption for hood-less installation make the Conveyor Oven speeds)to be running at the same time.
dem solution for ease of operation and high throughput. The single belt model has a 26'(659 mm)conveyor belt that
Conveyor Oven is equipped with dedicated upper and can be set to cook from left-to-right or right-to-left.
lower heating elements and air blowers.The air blowers direct
heated air through upper and lower jet plates inside the oven The 50/50 split belt model j d o v
chamber, above and below the food.A conveyor belt moves has two separate 12" "
mm) ��
product continuously from one side of the conveyor, through (304 conveyor belts. i •�,
the oven chamber,to the opposite side of the conveyor. Each can be operated ljr
independently and can be i
Operator controls consist of a touchscreen, a Standby switch, set to cook from left-to-right � ��
and a Main Disconnect switch.Adjustable door panels on each or right-to-left.
side of the oven chamber can be used to customize theIii
chamber opening height. Two removable crumb trays, one
below each side of the conveyor,allow for easy cleanup.A USB Two 12"(304 mm)
port allows the uploading of pre-programmed menu Items, Conveyor Belts
installation of software updates, and opportunity for service The 70/30 split belt model" o ' v
diagnostics.A 6'(1829 mm)cord and plug set is standard. has a 17' (431 mm) �'
Model C2000 conveyor belt and a 8" j /##
(203 mm) conveyor belt.Model C2000 is a standard,single belt conveyor oven.It has a Each can be operated 120'(508 mm)conveyor belt that can be set to cook from left-to- independently and can beright or right to-left. set to cook from left-to-right
or right-to-left. ;IVO 17"(431 mm)
• Conveyor Belt
8"(203 mm)Conveyor Belt
Left Side of Right Side of
Conveyor Assembly Oven Chamber Conveyor Assembly
Main Disconnect Switch
(located on side)
Adjustable
Door Panel
Illftppr I
Conveyor Belt A o 0 Q
0 .4� 0 0
0 o Conveyor
rl �.� — 0 End Stop
el
\__ •-_______ .
Conveyor
End Stop o ® �_ v
d s _
d o b4 �UI Cmb
Oven Door Tray
I.
Touchscreen
USB Port
Standy Switch
Model Description(Model C2000 shown)
4 Form No.OVCM-0416
MODEL DESIGNATION
TCXXXX
Oven Type:J Model Number:
C =Conveyor 2000=20"x 20"Cavity With Catalyst
2000NC =20"x 20" Cavity, No Catalyst
20003PH =20"x 20"Cavity,With Catalyst, 3 Phase
2600=20"x 26"Cavity With Catalyst
SPECIFICATIONS
Plug Configurations / 1
Units are equipped with an electrical cord and plug appropriate
for the electrical rating of the unit.Unit must be connected to a
dedicated circuit. 1 I (P-, I
A WARNING / II
ELECTRIC SHOCK HAZARD: Plug unit into a properly NEMA6-50P NEMA 15-50P
grounded electrical receptacle of the correct voltage,size, J
and plug configuration. If plug and receptacle do not
match, contact a qualified electrician to determine and Plug Configurations
Install proper voltage and size electrical receptacle. NOTE:Receptacle not supplied by Ovention.
Electrical Rating Chart
1
Plug
Model Voltage Kilowatts Amps Phase Hertz Configuration Unit Weight
C2000 208/240 9.2/11.8 44/49 1 60 NEMA 6-50P 226 lbs.(103 kg)
C2000CSA 208 8.3 40 1 60 NEMA 6-50P 226 lbs.(103 kg)
C20003PH 208/240 12.0 34 3 60 NEMA 15-50P 243 lbs.(110 kg)
C2600 208/240 12.6/14.7 37 3 60 NEMA 15-50P 266 lbs.(121 kg)
NOTE: Ovention Conveyor Ovens are designed to accept NOTE: The specification label is located on the left side of the
either 208 VAC or 240 VAC. The oven will adjust unit.See the label for the serial number and verification
automatically to the input voltage. of unit electrical information.
Temperature Range
The operating temperature ranges of the Conveyor Oven are
as follows:
C2000/C2000CSA=300°-525°F(149*-274°C)
C20003PH=300*-550°F(149°-288°C)
C2600=300°-5509F(149"-288°C)
Form No.OVCM-0416 5 Q EN 1 1
/l.,/ 1, 1 /rlr, , // / 1 f ty A: 1,, l , 4
IFICATIONS
ensions
Overall Depth Height Footprint Footprint Rear Platform Body Platform
Model Width (A) (B) (C) Width(D) Depth (E) Width (F) Width (G) Width(H) Depth(J)
C2000 60-1/4' 37' 20-1/4' 20-5/16' 26' 35-1/8' 19-5/8' 21' 20-5/16'
(1531 mm) (940 mm) (514 mm) (516 mm) (659 mm) (891 mm) (497 mm) (533 mm) (516 mm)
C2600 60-1/4' 43' 20-1/4' 20-5/16' 26' 44-1/8' 19-5/8' 21' 26-5/16'
(1531 mm) (1092 mm) (514 mm) (516 mm) (659 mm) (1121 mm) (497 mm) (533 mm) (668 mm)
A ` B 1
/ .............
= ,_...______________;, itigiaill ,, ,,,, ,, .
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/� /1 Front View Side View
,� /` Oven Cavity Dimensions
Model C2000
:fit` Power Cord� it 20"W x 20"D x 3-1/4"H
b 1 `1 _ F lh (508 x 508 x 82 mm)
/ �1 / S ecification Label I Model C2600
/� ,,k,. on left side of unit. - 20"W x 26'D x 3-1/4"H
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