HomeMy WebLinkAboutFontana Foods 731372 , - 0Application for Temporary Food Establishment Permit
(To be completed for each booth at least 2 weeks prior to the event)
w County $75 fee applies I Please wake checks payable to Catawba County Environmental Health
cataMail to:Catawba County Environmental Health,PO Box 389, Newton,NC 28658
public health
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SJAKING•HMO.BEIM. ""All parts of this application must be filled out before turning ins"
Establishment Name
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Operator/Owner Name (PN-( �—�‘,v (, v\ J 4 I 1) X 1% 73 i 3 1)
Mailing Address_ �� ,�'` 7 s / c_-)`%-2 C -qv `E c �='f �4- L % L �lC,
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Telephone (daytime) �? �'ys'" (evening)
E-mail Address: A ,, — 4E- e (; c_i a c__ / , (2 C
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Name of Event/Festival/Carnival; etc. G%t ce_ ,4ic i
Dates& Times of Operation -'-C-- `- �. /L—7. Z — •4e"A! /r --
Event Location l;lte-L '' Setup Completion Date& Time 510' i � 30
Signature of applicant
Menu: Attach menu or list all food items to be prepared 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.
Foods a a' Isa,
o
ci
0 0 a 0 0 `o 0
1- v st 1 V V Z OC = _ a- a
( ( ,a . 12_, it ❑ - , Ef
❑ ❑ ❑ ❑ ❑ ❑ El
❑ ❑ El n ❑ ❑ ❑
❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑
- ------- -
❑ ❑ ❑ 0 0 0 ❑ ❑
Foods Prepared and Cooked Offsite:
Name of Permitted Establishment 'v./ ^v....--
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.
Foods °en
'
'a •v
.._ M 0 0 0 o lb 0 `0 0 0
ti a V V v Z OC Z = 0� a
— — —
a
II 6 IF
_____,
_ . ...... . .
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
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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.wi_
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4,A • CATAWBA COUNTY
t`[` a l 100A SOUTHWEST BLVD
Cj NEWTON,NORTH CAROLINA 28658 RECEIPT
V ,�„ 7 PHONE:828.465.8399
Wednesday, May 24, 2023
18 4 2 snt www.catawbacountync.gov
PAYOR: Fontana Foods
Fontana Foods(Fontana,Ray)
PAYMENTS
TRANSACTION NUMBER: TRC-64783863-24-05-2023
PAYMENT DATE: 05/24/2023
PAYMENT TYPE: Cash
INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT
05-23-423171 110-580200-663000 Temporary Food Establishment S75.00
Fee
TOTAL PAYMENTS: $75.00
FLI-05-2023-196607
CASE TYPE: Food&Lodging Institutions WORK CLASS: 73-Temporary Food Establishmen
SITE ADDRESS: 1960 HWY 70 SE,HICKORY NC 28602
Applicant FONTANA FOODS,PO BOX 151292,CAPE CORAL FL 33909
**NO PEOPLESOFT ACCOUNT ASSIGNED**
receipt 05/24/2023 15:24 Page 1 of 1