HomeMy WebLinkAboutFLI-11-2022-184095.tif ill"
Application for Temporary Food Establishment Permit
`'' (To be completed for each booth)
c at aw b a count $75 fee applies I Please make checks payable to Catawba County Environmental Health
y Mail to:Catawba County Environmental Health,PO Box 389,Newton,NC 28658
public health
MATING.LIVING.rum, "AU parts of this application must be filled out before turning in"
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Establishment Name al R1 C(/ tY I ) 1C 11 31 ?7`.3)
Operator/Owner Name SU �� Ve 'eir
Mailing Address 2 L Ct r lx iif. fv'Q . #K t Z.! C, 111 Wari7br Tkt • NI- o 48 .34
Telephone (daytime) Goct r05 043140 v (evening) na C Jame.)
Email Address: 5u'��ail2�` �' m a l `corn
Name of Event/Festival/Carnival;etc. ,V'e ' WA) 2072-.. ►""on 56 uk, w i sE?J
Dates& Times of Operation Nolzm 1" 'Lit 2":71-2'
Event Location 3 5oa Roc-A(1 Fora Rinwi,Setup Completion Date &Time 146veInbe 23t2021' &cf
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Signature of applicantNAIlgY"
Menu: Attach menu or list all food items to be prep red 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 15A 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 ED#
Establishment Owner/Manager
Establishment Address
Establishment telephone#
In the table below list ail foods prepared in the permitted establishment and check all procedures performed there.
Foods a i C
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Sources of all meat, poultry, seafood and shellfish:
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Method of storing and disposing of wastewater.
Booth sketch:
Draw the food booth, Identifying and describing all equipment, including haadwashing facilities, equipment washing
facilities, 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 laa .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/EnvironmentalHealthl
TempPood.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.U.Box 389
Newton,NC 28658
Phone:(828)465-8270 I Fax:(828)465-8276
Email:El/Advil.aim trativcNaristcolt ( CatawbaCountyNC.gov
4, NEWTON,
CATAWBA COUNTY
100A SOUTHWEST BLVD
NORTH CAROLINA 28658 RECEIPT
u In PHONE:828.465,8399
Thursday, November 10,2022
1$42 sm www.catawbacountync.gov
PAYOR: Thai Rice/Train
Thai Rice/Train(Pepper,Supha)
PAYMENTS
TRANSACTION NUMBER: TRC-50924172-10-11-2022
PAYMENT DATE: 11/10/2022
PAYMENT TYPE: Credit Card
INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT
11-22-414590 110-580200-663000 Temporary Food Establishment $75.00
Fee
TOTAL PAYMENTS: $75.00
FLI-11-2022-184095
CASE TYPE: Food&Lodging Institutions WORK CLASS: 73-Temporary Food Establishmen
SITE ADDRESS: 3500 ROCKY FORD RD,NEWTON NC 28658
Applicant THAI RICE/TRAIN,2 LARUE AVE#K12,EGG HARBOR TWP NJ 08234
C:6097050616
**NO PEOPLESOFT ACCOUNT ASSIGNED**
receipt 11/10/2022 16:52 Page 1 of 1