HomeMy WebLinkAboutCBPR-09-2022-42457.TIF ( )
ENVIRONMENTAL HEALTH
Catawba county Catawba CaetrGovereeeetCeahr
public health 25 Goveromet Drive I P.O.lax 389 I Newtoe,NC 28658
•, •: Phu:(828)465-8270 I Fax(828)4654276
Email:EHAdmin@CatawbaCountytiC.gev
Food Establishment Plan Review �`�- ��
eve Application
e of Construction• New n R...,l.l n Exhp
\/ ►
Nova of Establishment: V Gjff existing,
Address: S�'tee of old a hme
toblEiet if hewn:
wCity: 0
S +e a
We:NC ZIP Cede: a 8 o a
Phone(If avofloble):
Fax(if available):
owner or%veers Rep, etdtiva:
Address: a1L �}ar t)vdn Road
City: fT i ck oti't,, Slate:NC ZIP Cede: a$LP o.
Pk...(N unllabfe):NM) U liS-b 3 2 Fax(if available):
E-mil Address: l klie e M MI I • Cam
Sebniter: To vee, Ly
Company:
Coated Persoa-
Address:' g 4"rcur-imn Rona
ai r: 11 Cat—0 Yt State:NC ZIP Cede: P,X l0
Plano(if ava8abk : 41.4 Y g r DS-3 Fax(if available):
E-eaaii Address: `ri 4 ' e ifY1 , C a m
Title(owner,sonogid,architect,etc.): Dw1
ftor
I certify that the information in this application is correct,and I understand that any deviation
without prior approval from this Health Regulatory Office may nullify plan approval.
(owne o sponsible Represen e)
Signature &Date:
Hors.f°prase ^�
Son Soo I Tee 1 I -(D Wei I I—Lp ri. i ►—to Fri I I—LP set I I—In
P ada ream of soh sorwd Mtre.e prided deliveries+ sldtsf Laub AO Diner o�
Mssdrr of Si.t:: 102 Fairy told noire het: j `J
Pr9ladd coot/Win start daft: f 15) 0 a ProlocarrIcsitrodiar c spl.ti..Ant fah . (s i , a3
Type of Food Service(dud dl tid apply)
❑Ratoorad ['tahring Sigl.-snria(dispese6k): Iid Metes 12/Glesawer. G Sil erwsr.
OW stool Eftk-d si weds
ii the find Q`fik.-..t s.ds Mehl-a.(nesabk): ❑Pht.s ❑Wasswr. ❑Simon
❑Gssissry ❑Nod nubs
Mier( )
Specialized Processes
Meese Wiwi pf I try warmed paces=trill be eat
❑Cerig ❑Acid fiarti a(ask,etc.) ❑R.dead.:ype ped<egig(rtcees sell)
tiia ksg ❑Spr..Aep ken ❑otMr J�
Expiois dwdced processes: Sm 1(IL S .ok�x- T l r1 n --ul.-)
Populations Served
Wade ety• fie hfowig YpYy ssscepllbk popdsfees Ike ad be a wed to et semi:
❑N,*Ms. ❑cWd are coder ❑Sdnl wRlt pro-scMd pi Miro
OAsebs.d frig odor ❑il rti are hd®y
Please Enclose the Following Documents:
• Proposed menu items(including seasonal variations in the menu).
• Manufacturer specification sheets for each piece of equipment shown on plans.
• Site plan showing location of business in building,location of building on site including alleys,
streets and location of any outside facility(dumpster,walk-ins,etc.).
• Plan of facility drawn to scale showing location of equipment,plumbing,electrical service and
mechanical ventilation,including location of all electrical panels.
A
Contents and Format of Plans and Specifications
1. The pW sheik he r ikon all z 14 Wise i d the lend d in floor to saws*drewm a.whim of a 1/4 WJw•1 fed.
lib b*dew 1r sass h reds}
2. lipid's wampe,ls,i does shad ibis tb p►.pi+pea,.dog up.dfy,d prelocted doily seed cows hr bed service sprs.
1 11N pW shad show the hake s.d,Ass repassed,co dewed kph!a d id woks wiped.Imo pia a'Omni del he dads
lahebd es she phi wih Ns awes sews.
4. Aiq.*rued cols,h lWleg b kris d skip./..,d het-6sldi9 hales fir Worlds 4mkws feed VW)shad he slowly
dwipard a the shim
5. When she wee idea,espouse hod premisn duo desk he killed wed lasted I.pmd.du adueb/es rot crems-ceremWeWee a raw ad
romdpA-omt
6. Monde Ness weiis,IdI/w aid fw a ether pips shoed be dodged fr moth tdie hay Ned*the Ifadds wee a lad popery/es
d dish wwi",ern.
1. The pi.{gat shed coda new die,aide specs,spice between wet bolded griped,d the plummet el she s,s>lwsd.she low.
II. belay raw nth is strap reumo,primp news,*lots,hessweds.d/w clan ud for dersp r bad remiss shook he speed
.he phi mad d bows of ire news dews s mad lobe doodads.
9. The plus d sp liw/s=shoed the Wok
A. Mazes,rifts,Iseisp dndiq erns d decks
i. Cwpbad f*fi*iodise lr smut ism w irks leen,was,amp ai awed(mare hew upprad mdwias br feed props/*,
hdNy sod steep wen*dude quay Ile,amok Me,waled am°se,c.sewwd l hokum,burghs►uiiwmd peek.lies stud,
wa bend pddd whi womb,..wbs.i plat,w*y1 ceded adN.g ties,d kick,drier Ideas,slog Medo,r made Wed;I
glrik,11101,pimdenk r sled n is se Fwd.e!ash seam.If spedfylas she use a r■awN and.ib l0,*ids■i>!b a the
mdere far wadi..
L P mm*Riede*t*Weds lentils a she her inks,leer deb d water smoky less,nuheed else wor Nees,hen wow Ness,but
mow p or swiped with copeck/d reawry me,heck law prer.fa,vs*wits ib ceod...6udrd Isnot,amend
10. lip dIg Repress*
A. Whams when a bud umpbyw I wwideg ski fad er wri cep wish leads w*pose nth a fair,slwrs,Oilers r srwR when
.mpiso whey b.hAr d ion busk 50 hot mike(540 he)
1 la wide Miters/se.ism d dry Ind*Nip rum d*sir wen d reams duds,prtuds a hone d a soma a 30 idles(75
cd)ohm is Inn 10 fest udw(101 hew)
L tidy i hod wwih i,taws wwh*j ecipsed.d dead Prop sot i slat ruses shot he w.sud d 30 lade(75 m).lass the
her wdd4r at is waft brut wtd swipeest zed its. Prep sad filet reset 20 bud nodes(215 la)
D. At swims when lad b weeded far compeer eel-sinks soh s Nab*d odd hen r where fresh proses r whelped hods en sold w
*Hued hr aapmp/e.,Wide ge1pwed no us s n.dtdu.d dsrwwlsr nhipdac 20 bet codes(215 bs)
F. light hie la bud pnpwda,Prep,d dhplay Ines id be shrer-pna r shielded se s te pledge she piny ef him kris sr
Imps fdlag its feed.Sider fraud r Jaded his mod at he rod la hot shop wen wire she keegkty el she.eyed pedlars
NI and he shod by inks.Ow Nis,Ids thew d is pampa,per te kris sped,ere wale ef helm dwd.Hod lamps Jot
he pretedud mime bream,y m shed serreaim Ned ninths,hseed is bi,lorries sky is law el she hi sawed la feed
propels.wee.
I I. bows shot d had wres,ftikbee*pot b NSF hdendie d(NSF)heed,edreaten{hated.ha.,C om ii d kr kabala er I est NSF or
IH Ieed,dad1.d,he asirsdg Is min NSF'duds us spdbd saoriiq is ISA NCAC 11A.2600,2009 NC Feed Cede 44 thrash 4-3.
12. Sirs a wont sway d eked el imp dtspssd.The liaise el shod Whin n deed he shoed Mien seheted d den d lead
rupeldbas n hi he coddled ad.
Ile is spsdisd.aeriig le ISA NCAC IU.2600,2009 NC Food Cede 4-903.11(AHD),3-305.11(A)rot(I).All his sired I roams where bed If
sipi►opke hoes we deed Jot he d land 12 la(30.41 sus)show she flow whom plead em deleu p Prep was w 6 W(15.24 at)mine she
Imo she plead a pr S Pero,its r et erwbe rnapd se s to pest shanyh deism.
14. Y.dde sled&ler sad ream.
IS. Wisp new wits,woftncly.As spied uardlai s iSA NCAC 1110.2600,2009 NC Feed Cads Maul 5.203.13,Mei*g Spiess,
*ode holden Rid he prodded far the moths d Pnnis ef d primp awe.The datt*hdh/s Ali*dads a ceai*ae fend,hes d
all wow,.shraded was wed a swig*wan poi,.Nid eW rsaWW.ded she el 36 36 x 4 wli ids l.bad hip ashy de he
wet..sew Pot w■bisit e1 41*chose A Jell my miss he prahlud for the Propel denims sepals rinds.Hie ugh b IOW s
r amhiada w wdyiep sib she is Weise mounded do ler this molt Is 36 y 36.
I6. Dump*pi d head..'paled wadi. ISA NCAC 11A.2600,2009 NC Fog Code lad 5-5 bins,Nrpdhdes and bdoneiles.
17. Gress rep sW,hr{pen la plr Who.
II. Gnome Prep metiers sg Prep lied...
19. Ciids,iisiuss for Pwlag loos shrrmik.
21. ail peas,later ssti modems nit suss .d/i►art nalb.rquisd.
21. Candied Jedi t.
a S .lot(9181 per)
Cold Storage nn��
Mdhd esd drten to ile csW stomp rpalrn `Ala` la (nO
Cubic feet of reach-in cold storage Cubic-feet of walk-in cold storage:
Reach-ie refrigerator stomp: ft Welk-Ie refrigerator storage: 5 X Li ft
Renck-in freezer storage: ft Welk-Is freezer storage: 5$(p ft
Number of read-la refriganters: Number of walk-le refrigeraNrs: I
Number of reach-le freezes: Number of w Ar-ie freezers:
Hot Holding
ilt*ds that be bold bah
rice,, &Lam. w ei3S ) s
Cold Holding
List foods that wiq be beW coW:
sc dwick moois , ve i es 5ah&wich,e.5
Cooling
iodic*by decking tie oppreprfete boxes bow cooled food will be cooled to 450f(IOC)within 6 hours.
Cooling Process Meat Seafood Poultry Other
Shallow Pons [3" ❑ fQ' _ ❑
Ice Rath ❑ _ ❑ 0
Rapid Chin C1 0 0
If Other is decked Ldicde type of food:
Thawing
Indicate by c eckieg tie sppropriete boxes how food is sock aetop y will be*owed.
Thawing Process Meat Seafood Poultry Other
Ralri,enthe ❑
hooka Wider less ties 10 f(21 C1 p❑ , ❑Caked Fran
n ❑
Microwave ❑ ❑ ❑ ❑
If*bur is cbodnd idids type of feed:
1
Food Handling Procedures
bpIsle td with es na deletl os eoe desa pdees of tie specific erns of tie idea aced corresponding
pMm where feed will he headfed.
Explain tie haadlig procedures for the'drag oategedes of Ned.Denim the process from receiving to sepias hdud*
• 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
Ready-to-Eat Food Handling
(Wible widowitiessl preperetha necessary,e.g.,Weis,cud sandwiches,raw nano'shellfish)
I w
Produce Handling
WM produce be wean er rinsed prior to use? fixes ON.
Is there en approved loathes used for witting or rlssi g produce? Dies ❑No
Will it be used for other spondees? ❑Yes [alto
Please indicate loathe of rodeo wesMug equipment and describe the procedures.Indude Nose of Jay aid frequent for
washing or rinsing the produce at this Maths:
S t kk - blur rice (&I Jot — Uad< p1 p aye C�
Poultry Handling I
Will poultry be washed or rinsed prier to use? CAM ON.
Is there a approved loatee used for washing if rinsing poetry? Wes ON.
Will it be used fir other spsratism? Oyes Ale
Phase indicate Indies of pastry washing oquip■at and dada the procedures.hdude tine of day en hogoncy for
wallet or rinsing the pastry et this lecdtea:
rile at S1 hit.nrluAI4/
Meat Handling
Mill perk and red meets be wedged or than prior to um? ❑Yes Isle
Is there a approved leaden mod for wising or rinsing perk end red mods? Mad & Iles ❑No
Will it be used for other sperofhns? ❑Yes ❑Ne
Mena Wale Marisa of meat washing mimed and describe the procedures.Iodide time if day end'regency for
mashies or rhslog the we.,et this location:
ba.d< ?ay ay to.,
Seafood Handling
Wil mind be meshed or rinsed prier to�� ❑Yes ❑No
is then a npp w.d hales mod far washing or rinsing Wood? ❑Yes ❑N.
WS I be nod for other spending? ❑Yes ON.
FNen Made Marisa of ssofoed wmhisg equipment end denim the proadans.Include limo if day and hammy far
Ins*or rinsing the sodenn at this Kadin:
Dry Storage
Praefie Women ea he fragaeary filthy*:mil it mgechr,rog,raf e■a Ibt b h it 1eEmu owl time:
axl -ee-k, 5ro5S VnhiLrn P Mew V `e-a es
km fest of dry stirs,'stiff spas: 2 0 ft + b&'9°f d,i-,Ikk- cST 7`7i)'v
Wien will dry,ads be shred?
i; Tef are
rcji '1(h0 (Q'� (ohm -r-d Brea t
.{''
Finish Schedule al.I
e)c hek- uuto nuAa-
Wade Rear,wall adnem Rialtos(ay.,quarry lie,s steel,vinylorder euatic tile) 1
Area Floor /� Base Walls Ceiling
10ldtea I C./ ` `�` D Lad) - I -k P.5
Bar iJA- nTi{'.
Food Storage i 5�fL Q I�
Dry Storage V n� ac
Too Rooms
7
Dressily Rooms
Garbage mod
Refuse Storage
Service Sisk
(wp/res4 cm wash)
Otber
V
Water Supply and Sewage
Water supply: [Maddpul DWeq
Sewer: 'fiakipel peptic
Ice: gado a promises nPurckssed
Water Heater QJ�/4- re , i
Tank Type '^'/" �Y' �
Measfodaror. Mew
Storolo Capacity: gallon
Electric Water Hector: kilowatts(kW) Gas Water Heater. ITUs
Water heater reaerery rate(/affees per hoar at 10F/90f ts.psratare rho): GPH
tl (See Water Heater CaWater oa the Play Review Usk welsh to cables recovery rate needed)
Tuskless
Maaufadarer: Model:
Qnatity of tcal less water heaters:
Check the appropriate box indicating equipment drains:
1 Indirect Waste Direct Waste
Plumbing Fixtures Floor sink Hub Drain Floor Drain
/ Wwwissiii Sok ❑ ❑ !J ❑
✓ Prep er ❑✓ ❑ tglA ❑
✓ tw'ulds.Sisi° 121. ❑ ❑ ❑
Wswasiii Wise IV& ❑ ❑ ❑ ❑
✓ b nadir ❑ ❑ C✓ ❑
Wisp Duped Nip. ❑ C ❑ ❑
Dippirwa ? ❑ ❑ CI ❑
` 'y �X i5Vi n9 ❑ d ❑ El
,/SionT.w fa,A„ ❑ ❑ ❑
Dior
❑ ❑ ❑ ❑
Odor 0 0 ❑ ❑
r
Warewashing Equipment
Manual Warewashing(Rid be 3-oe.part.at sigh) LI
i t
She of ski components: 94 i. Widlb ,,.I�r'
, I. Depth Xi I.
i
Wild typo of smithy tfw will be sod? [✓{bbd.. Podia 0(Memory Aa...lem ❑Net Vid r
Oiler("y):
Mechanical Warewashing 'v�, I/fA.
Warewasbf g Necktie.r.aafechrer: M.del:
Type of saahhatiea: Elliot water(180 F) Damns!
General
Dwane bow cooki.0 eq.ipe.t,cutting boards,slicers,center tops sad other food coated surfaces that ca..ot be submerged
h Onb or pet through a dishwasher will be deemed ad sanithod:
- 1001 I Old- C'Ae avu�9 .col =t O In eci u.ir,ne)At - tope. GU-) -i- ,c0JA .-1-i 71 d i ) C A o r .2.
Desa lbe belles cad type(drunkards, II-■a.tod or overhead shires,steamy or portable milts)of air dryiug space
walk, oto d '- s1kave
Square feet of**yip spew: ft
Handwashing
Number of hndwasbiug si.b: $ 02
1 . /
61'.
acts itR ,. .� k
Employee Accommodations
Lucille.for qI ie.s:
An
Refuse and Recyclables
W01 refuse be shred inside?0 N. ❑r.s,et
Provides ter refuse disposal: [7 D.arpster flf.ppeder
Prevision for deaafug d.rpster/awpedsr: ❑ou-sil. ❑Off-site deans
Off-sits deeming centimeter: taivU
fJ r(, ,
Dosail7
Wks for snap if recydables(cooking pause,cidbe.i,Omskotc.):
s--rA' -fYr, - m ra ± 0oaa-d jYtTI
40.4ti1 1oret,
Service SinkfAt'
Locative lad size � `� 01 ere S
"rice(beep)�k/e.n or ,. ,�►,
wash:k o separate loop stomp Nu prided? (`file '113
❑Yes n
Insect and Rodent Control
How is protection provided of oil outside dose? [
Sell•dosie0 door 0 Fly fai
Row isprotectie provided on*odor? osh? 0 Sell.d Saeei doer
� ��'h' ❑Sve*dp
Linen
lid loathe of dean aid dirty line storage:
S
Poisonous or Toxic Materials
Indicate location_of peisenes old/ tak wateriak(ckondais,f dims,etc)storage:
Menu for V's Kitchen
Items Description
I. Plates rice & meat
1. Char Sui Plate Char Sui, white rice
3 eggrolls, fried rice, sweet sauce,
2. Eggroll Plate shrimp sauce
3. House Fried rice
plate Rice, Chinese sausage & chicken
4. Lemongrass Chicken
plate LG chicken, white rice
5. Meatball Plate 3 meatballs, white/fried rice
6. Sausage Plate sausage, white/fried rice, pepper
7. Wing Plate 2 wings, rice, sauce
mayo, pate,jalapenos, cilantro, pickled veggies
II. Sandwiches (daikon & carrots)
1. Banh Mi (regular
cold cut) pork roll & headcheese meats
2. Char Sui Char sui meat
3. Lemongrass Chicken Lemongrass chicken
4. Meatball Grilled meatballs
5. Sausage Asian sausage
HI. Noodles (Pho) Beef broth soup with rice noodles
1. Beef Pho beef + noodles
2. Meatball Pho meatballs + noodles
3. Pho Pao beef + meatballs + pork roll + noodles
4. Pho V chicken + noodles
IV. Sides
1 veg eggroll
1 chic eggroll
Fried rice side dish
Wings 2 regular wings
White or fried rice side serving
Fried egg (sunny side
up)
V. Drinks: Bubble Tea Tea + milk + sugar syrup + baba pearls
Bubble Tea (20 oz.) 1) Coffee
2) Lychee
3) Mango
4) Strawberry
5) Taro
Butterfly Tea (purple) add lemon juice & sugar syrup
Hibiscus Tea (ruby red) add lemon juice & sugar syrup
Dalgona Coffee
(whipped) coffee, milk, sugar syrup, ice
Canned drinks variety drinks and bottled water