HomeMy WebLinkAboutRed Carpet Amusements 731373 G) .
Application for Temporary Food Establishment Permit
(To be completed for each booth at least 2 weeks prior to the event)
C county $15 fee applies 9 Please make aerks payable to Catawba County Environmental Health
Mail to:Catawba County Environmental Health, PO Box 389,Newton,NE2808
public health.._...._....,:.... Z j US0L?)3 - I CIlr lr 01
UAN{NG.Bliss. 6177F11. **All parts of this application must be filled out before turning in**
kv...:4 C. �': .(-'(_ -A01, cc. w( F I )) ')D I IS—)3 1313
Establishment Name ,' /(__:? to 0 ft.�2 �)� mow v —
Name L(—% S ; A2 A 7.
,iP.M.01 6 Operato Ower
Mailing Address / / Cr) ,-L�.-1.-tQIM -23 S'c-r-->-__
Telephone(daytime) Zc..) y- c /4P`3121 (evening)
E-mail Address:
Name of Event/Festival/Carnival;etc. ) Azee
Dates& Times of Operation -1� c .2 6 f 0 --l(
Event Location !�i-6-4:�j/ // Setup Completion Date & Time J J)u 0 3 v
0'
Signature of applicant --
Menu: Attach menu or list all food items to be prepared or served.
( ',)/1.4,-,,-Li ;/4.4,444.— C 4..62._ CRA)-“AeVa--- CtsOL„,......i./ .
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 ISA 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.
Foods _ n fi a,
c 0 0
.� a N 0 0 et 0 o 0 0 a
1--- k..1 Q v V v = CC Z Z a or.
A-t l - LJ 1 - ❑ (l. n ❑ ❑
❑ u ❑ ❑ ❑ ❑ ❑ ❑
❑ ❑ ❑ ❑ LI ❑ ❑ ❑
❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑
❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑
❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑
0 ❑ ❑ ❑ ❑ ❑ ❑ ❑
❑ ❑ 0 0 0 0 ❑ ❑
Foods Prepared and Cooked Offsite:
Name of Permitted Establishment 0 l Y -
NC DENR Establishment ID#
Establishment Owner/Manager
Establishment Address
Establishment telephone#
In the table below list all foods prepared in the permitted establishment and check all procedures performed there.
Foods12)
c.
3a = a as o`a� .c VVV avC 0 CC = = Q_
I
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 handwashing 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.
C-C) tAll°
rThi - , -
_
,c7
•
--
To
(ip r
4'A C CATAWBA COUNTY
100A SOUTHWEST BLVD
aNEWTON,NORTH CAROLINA 28658 RECEIPT
Qatiff PHONE:828.465.8399
Wednesday, May 24, 2023
18 4'2' sM www.catawbacountync.gov
PAYOR: Red Carpet Amusements
Red Carpet Amusements (Ianni,Gina)
PAYMENTS
TRANSACTION NUMBER: TRC-64783867-24-05-2023
PAYMENT DATE: 05/24/2023
PAYMENT TYPE: Cash
INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT
05-23-423173 110-580200-663000 Temporary Food Establishment $75.00
Fee
TOTAL PAYMENTS: $75.00
FLI-05-2023-196609
CASE TYPE: Food&Lodging Institutions WORK CLASS: 73-Temporary Food Establishmen
SITE ADDRESS: 1960 HWY 70 SE,HICKORY NC 28602
Applicant RED CARPET AMUSEMENTS,PO BOX 11310,ORANGE BLOSSOM TRAIL FL 33982
**NO PEOPLESOFT ACCOUNT ASSIGNED**
receipt 05/24/2023 15:27 Page 1 of 1