HomeMy WebLinkAboutEHPR-10-2022-42522.tif ENVIRONMENTAL HEALTH
Catawba County Government Center
25 Government Drive I P.O. Box 389 I Newton, NC 28658
catawba county Phone: (828) 465-8270 I Fax: (828) 465-8276
public health
MAKING.LIVING,WIER Email: EHAdministrativeAssistants@CatawbaCountyNC.gov
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Food Establishment Plan Review Application for Ownership Change
(Note:If the establishment has been closed for more than one year, then applicant must fill out
short form instead of this form)
Name of Existing Establishment: Applebee's Grill and Bar
Name of New Establishment: Applebee's # 1098
Establishment's Address: 2180 Highway 70 SE
City: Hickory State: NC ZIP: 28602
Phone: 828-328-1000 Fax:
New Owner's Name: Apple Hickory, LLC RECEIVED
O C 1 1 4 2022
Please Enclose the Following Documents
• Proposed menu items (including seasonal variations in the menu). Environmental Health
• Manufacturer specification sheets for each piece of equipment that may be added or replaced.
• Plan of facility drawn to scale(min 1/4" = 1') showing location of equipment, plumbing,
electrical service and mechanical ventilation, including location of all electrical panels only if
complete remodel and/or replacing, adding/moving equipment. That will be determined by
plan reviewer.
Hours of Operation Number of Seats: 160
Sun 11 am to 12 am Maximum Number of Staff per Shift: 20 +
Mon 11 am to 12 am Facility Total Square Feet: 4200 + / -
Tue 11 am to 12 am
Wed 11 am to 12 am Projected Start Date: N/A
Thu 11 am to 12 am
Fri 11 am to 12 am Projected Number of Meals to be Served (Approximate number):
Sat 11 am to 12 am Breakfast 0 Lunch 25 Dinner 60+
Type of Service
(Check all that apply)
✓❑ Sit Down Meals (i Push Cart
✓❑ Take Out ❑ Limited Food Service
❑ Caterer v Single Service Utensil Only
❑ Mobile Food Unit 1✓l Multi-Use Utensil Service Only
Li Other
Items that Need to be Addressed
1. Information plans should include; the proposed menu, seating capacity, projected daily meal volume for food service
operation.
2. Adequate rapid cooling including ice baths and refrigeration, and hot-holding facilities for potentially hazardous food
(PHF) should be clearly 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 cellars used for storage or food
preparation should be represented on a plan.
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/classified, be constructed to meet
NSF/ANSI standards as specified according to 15A NCAC 18A .2600, Rule .2654 and 2009 NC Food Code Manual
Chapter 4.
6. As specified according to 2009 NC Food Code Manual 4-4 all items stored in 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 (vinyl tile, acoustic tile,vinyl baseboards, FRP, etc.)
Area Floor Base Walls Ceiling
Kitchen QT QT FRP ACT
Bar QT QT N/A ACT
Food Storage QT QT FRP ACT
Dry Storage QT QT FRP ACT
Restrooms TILE _TILE PAINT ACT
Garbage & Can Wash Areas N/A-EXTERIOR
Wait Station Areas WOOD WOOD N/A ACT
Other
Other
Food Preparation Review
Check categories of Potentially Hazardous Food (PHF) to be handled prepared and served.
Category
ivi Yes ❑ 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.)
n Yes ❑ 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? ✓ Yes No
Cold Storage
Are adequate and approved freezer and refrigeration available to store frozen foods at 00 F and below, and refrigerated foods at 450 F
(700C) and below? 6/ Yes No
Provide the method used to calculate cold storage requirements:
Space dedicated to walk-in cold storage: 60+ ft2 Space dedicated to reach-in cold storage: 60+ ft2
Will raw meats, poultry and seafood be stored in the same refrigerators or freezers with cooked/ready-to-eat foods? V/ Yes No
If yes, how will cross-contamination be prevented? SPACED ACCORDING TO CODE
Does each refrigerator/freezer have a thermometer? ti/ Yes No
Number of refrigeration units: 3+ Number of freezer units: 1
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) ❑ I I
Cooked Frozen (indicate wt.lbs.) r I n
Microwave ✓
1
Other(describe):
Cooking Process
Will food product thermometers(0°— 212°F) be used to measure final cooking/reheating temperatures of PHF(potentially hazardous food)?
✓❑ Yes ❑ No
Minimum cooking time and temperature of product utilizing convection and conduction heating
equipment:
Product Time&Temperature Product Time&Temperature
Beef roast 130° F(121 min) Comminuted meats 155°F (15 sec)
Seafood 145°F(15 sec) Poultry 165°F (15 sec)
Pork 155° F(15 sec! Other PHF 145°F (15 set)
Eggs 145° F(15 sec) * reheating PHF 165°F (15 sec)
Hot Holding
How will hot PHF(potentially hazardous food)be maintained at 1350 F(570 C) or above during holding for service? Indicate type and
number of hot holding units.
HEATING STRIPS ON SERVICE COUNTER,WARMING TABLES ON COOK LINE
Cold Holding
How will cold PHF(potentially hazardous food)be maintained at 450 F(70 C)or below during holding for service? Indicate type and
number of cold holding units.
REFRIGERATION AND FREEZER DRAWERS ON COOK LINES, REFRIGERATED TABLE
Cooling
Please indicate by checking the appropriate box how PHF(potentially hazardous food)will be cooled to 450 F (70 C)within 6 hours(135°F
to 700 F in 2 hours and 700 F to 450 F in 4 hours).
Cooling Process Thick Meats Thin Meats Fish Seafood Poultry Products Baked Goods
Shallow Pans I I ❑ I- I
Ice Baths ❑ ✓ ❑ ❑
Rapid Chill ❑ ❑
Other(describe):
Food Preparation
Please list categories of food prepared more than 12 hours in advance of service.
ALL MENU ITEMS ARE PREPPED AND PORTIONED DAILY FOR PROJECTED SALES
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 an established polity to exclude or restrict food workers who are sick or have infected cuts and lesions? ✓ Yes U No
Please describe procedure:
PLEASE SEE ATTACHED PROCEDURES FOR ILLNESS POLICY
How will cooking equipment, cutting boards, counter tops and other food contact surfaces which cannot be submerged in sinks or put
through a dishwasher be cleaned and sanitized? Please describe procedure:
SANITIZER SPRAY AND QUAT ARE USED TO CLEAN ALL AREAS WHICH CANNOT BE PUT THROUGH THE DISH OR IN A SINK
How will ingredients for cold ready-to-eat foods such as tuna, mayonnaise and eggs for salads and sandwiches be pre-chilled before mixed
and/or assembled?
ALL PERISHABLES ARE KEPT REFRIGERATED, UNLESS THEY ARE CANNED
Indicate any specialized process that will take place:
Curing Acidification (sushi, etc.) ❑ Smoking
Reduced Oxygen Packaging (e.g.vacuum packaging, sous vide, cook-chill, etc.)
Explain checked processes:
N/A
Food Preparation Procedures for Facilities
Food preparation procedures are needed to obtain information on how the food is prepared and to
help determine that adequate facilities are available. The food preparation procedures should
include types of food prepared, time of day and equipment used for service in the facility.
(Attached is Food Item Preparation Worksheet Supplement for additional food items prepared in
the facility.) If your company has food preparation procedures already developed,these can be
submitted as part of the plan review approval process.
Produce Preparation Procedures
Will produce be washed or rinsed prior to use? Yes _✓j No
Is there an approved location used for washing or rinsing produce? ✓ Yes No
Will it be used for other operations? ✓ Yes n 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:
ALL PREP TABLES,SINKS AND UTENSILES ARE CLEANED BEFORE AND AFTER PREPARATION AND PORTIONING OF FOOD ITEM
Please describe the produce preparation procedures and indicate location of equipment to support this operation. The preparation
procedure should include dishes (proposed menu items) in which the produce will be used, and should include time of day and frequency
of preparation for the produce at this location:
ALL PREP TABLES. SINKS AND UTENSILES ARE CLEANED BEFORE AND AFTER PREPARATION AND PORTIONING OF FOOD ITEM
Seafood Preparation Procedures
Will seafood be washed or rinsed prior to use? n Yes No
Is there an approved location used for washing or rinsing seafood? n Yes ri No
Will it be used for other operations? n Yes U 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:
ALL PREP TABLES. SINKS AND UTENSILES ARE CLEANED BEFORE AND AFTER PREPARATION AND PORTIONING OF FOOD ITEM
Please describe the seafood preparation procedures and indicate location of equipment to support this operation. The preparation
procedure should include dishes(proposed menu items)in which the seafood will be used, and should include time of day and frequency
of preparation for the seafood at this location:
ALL PREP TABLES,SINKS AND UTENSILES ARE CLEANED BEFORE AND AFTER PREPARATION AND PORTIONING OF FOOD ITEM
Poultry Preparation Procedures
El Yes El No
Will poultry be washed or rinsed prior to use?
Is there an approved location used for washing or rinsing poultry? El Yes _No
Will it be used for other operations? ✓ Yes I I No
Please indicate location of poultry washing equipment and describe the procedures. Include time of day and frequency for washing or
rinsing the seafood at this location:
ALL PREP TABLES,SINKS AND UTENSILES ARE CLEANED BEFORE AND AFTER PREPARATION AND PORTIONING OF FOOD ITEM
Please describe the poultry preparation procedures and indicate location of equipment to support this operation. The preparation
procedure should include dishes (proposed menu items) in which the poultry will be used, and should include time of day and
frequency of preparation for the poultry at this location:
ALL PREP TABLES,SINKS AND UTENSILES ARE CLEANED BEFORE AND AFTER PREPARATION AND PORTIONING OF FOOD ITEM
Pork and/or Red Meat Preparation Procedures
Will pork and red meats be washed or rinsed prior to use? n Yes I I No
Is there an approved location used for washing or rinsing pork and red meats? k✓I Yes No
Will it be used for other operations? ❑✓ Yes U 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:
ALL PREP TABLES, SINKS AND UTENSILES ARE CLEANED BEFORE AND AFTER PREPARATION AND PORTIONING OF FOOD ITEM
Please describe the pork and red meats preparation procedures and indicate location of equipment to support this operation. The
preparation procedure should include dishes (proposed menu items) in which the pork and red meats will be used, and should include
time of day and frequency of preparation for the pork and red meats at this location:
ALL PREP TABLES,SINKS AND UTENSILES ARE CLEANED BEFORE AND AFTER PREPARATION AND PORTIONING OF FOOD ITEM
Design Information
Dry Goods Storage
Is appropriate dry good storage space provided for based upon menu, meals and frequency of deliveries? ❑✓ Yes ❑ No
Provide information on the frequency of deliveries and the expected gross volume that is to be delivered each time.
DRY GOOD ARE DELIVERED 2 X PER WEEK BASED ON PROJECTED SALES
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 Public Water Supply.
If water supply is from a Community Water Supply system is it registered and approved as public water supply? ❑Yes ❑No
Yes If yes, please attach copy of written approval and/or permit.
Ice: ✓❑ Made on premises ❑Purchased commercially
If made on premises,then specification for the ice machine will need to be provided.
EXISTING UNIT
Describe provision for ice scoop storage:
ICE SCOOPS ARE STORED HANDLE UP IN A BIN/SMALL LEXAN PROVIDED NEAR AREA
Garbage and Recyclables
Will a dumpster be used? ❑✓ Yes ❑No
Number of Dumpsters: 2+ Size: 20 YARD Pickup Frequency: 3 + PER WEEK
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 be discharged to the
sanitary sewer system.
Is the dumpster to be cleaned by an off site contracted cleaning service? ❑ Yes ✓❑No
If yes, please provide name and address of the firm contracted for this service.
Name:
Mailing Address:
City: State: NC Zip Code:
Telephone: Fax:
Will trash containers be stored outside? ❑✓ Yes ❑ No
If yes, please describe location:
RIGHT OUTSIDE BACK DOOR UP AGAINST THE WALL
Recycling
Type of waste cooking grease storage receptacle: GREASE TRAP
Location of waste cooking grease storage receptacle: EXTERIOR OF BUILDING
Is there an area to store recycled containers? J Yes ❑ No
Size of grease trap:
Location of grease trap:
Sewage Disposal
Is building connected to a municipal sewer? 0 Yes ❑No
If no, is private disposal system approved (septic system)? ❑Yes ❑ Na 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 without prior approval from this Health Regulatory Office may nullify this
approval.
65\js
Signature: Etythetb . f raA Date: 16'1 Z126Z 71—'
Owner or Responsible Representative
GRAYROBINSON
Jandianne J. Chamberlin, FRP, CP I Jandianne.Chamberlin@gray-robinson.com I D 813.273.5029
401 East Jackson Street, Suite 2700, Tampa, Florida 33602 I T 813.273.5000 I F 813.273.5145
October 13, 2022
VIA FEDEX STANDARD OVERNIGHT RECEIVED
Catawba County Government Center
25 Government Drive, OCT 1 4 22
P.O. Box 389
Newton, NC 28658
Environmental Health
Re: Applebee's#1098
2180 Highway 70 SE,
Hickory,NC 28602
To Whom it May Concern:
On behalf of our client, Apple Hickory, LLC, we have attached the Catawba County Transitional Food
Establishment Application and a check for the fee for the above mentioned location. We have also attached a copy of
the most up to date menu. The sale date is set for October 25,2022.
Please consider this application a request for inspection as required to issue the permanent license.
Should you require any additional information or documentation, please contact me via phone or email shown
above.
Sic y,
Jandianne J. Chamberlin, FRP, CP
Licensing Specialist
Boca Raton I Fort Lauderdale I Fort Myers I Gainesville I Jacksonville I Key West I Lakeland
Melbourne I Miami I Naples I Orlando I Tallahassee I Tampa I Washington, D.C. I West Palm Beach
gray-robinson.com
y�y'A CATAWBA COUNTY
It. �/ 100A SOUTHWEST BLVD
�' NEWTON,NORTH CAROLINA 28658 RECEIPT
c1\ PHONE:828.465.8399
\ �� Friday,October 14,2022
I8 4'L $ wvvw.catawbacountync.gov
PAYOR: Gray Robinson Attorneys at Law
Gray Robinson Attorneys at Law
PAYMENTS
TRANSACTION NUMBER: TRC-49094045-1 4-1 0-2022
PAYMENT DATE: 10/14/2022
PAYMENT TYPE: Check 543858
received by mail
INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT
10-22-413504 110-580200-663000 Food and Lodging Review Fee $75.00
TOTAL PAYMENTS: $75.00
EH PR-10-2022-42522
CASE TYPE: Environmental Health Plan Review WORK CLASS: Other FIT
SITE ADDRESS: 2180 HWY 70 SE,HICKORY NC 28602
Applicant APPLEBEE'S GRILL&BAR,2180 HWY 70 SE,HICKORY NC 286(12
Paid By GRAY ROBINSON A 1'ORNEYS AT LAW,PG BOX 3068,ORLANDO FL 32802
C:4078438880
**NO PEOPLESOFT ACCOUNT ASSIGNED**
receipt 10/14/2022 16:58 Pagc 1 of 1
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