HomeMy WebLinkAboutFLI-05-2023-195800.tif #1A111.
1w�ti
catawba county
public health
AUTHORIZATION OF REFUND
Date: 5/25/2023
Case#: FLI-05-2023-195800
Applicant: Tasty Pizza Hut
Refund Amount: S75.00
Refund Reason: TFE not required making in restaurant no handling in field
Authorizing Signature:
Received By Staff:
*;� 10Ic .
Date: )(?, 2)2
catawbacountync.gov
Environmental Health
Catawba County Government Center
25 Government Drive I PO Box 389 ( Newton NC 28658 I 828.465 8270
MAKING. LIVING. BETTER.
Catawba County, North Carolina - Disbursement Voucher
Vendor No. — Date: 5/25/2023
Make Payment To: �11;41Cp� Voucher No(s)
Tasty Pizza Hut ACI
1625 Clement Blvd NW d ��r�1 y
Hickory,NC 28601 v
j8 42
ATTACHMENT
Prepared by: Julia English
Description Amount
FLI-05-2023-195800 TFE not required. Making in restaurant, no handling in field $75.00
Sub-Total
Food Tax
Sales Tax
Total $ 75.00
For Accounting Use
Fund Cost Center Object Project Amount Only
110 580200 663000
Total
The undersigned hereby certifies that the goods or services specified above have been received
or performed. Payment has not been previously authorized and this expenditure is a proper
charge to the appropriation indicated. The above charge is certified to you for payment.
(SIGNATURE-APPROPRIATE OFFICIAL)
�4'p' • CATAWBA COUNTY
I00A SOUTHWEST BLVD
+ 1-3 NEWTON,NORTH CAROLINA 28658 RECEIPT
y
ar,
o y PHONE:828.465.8399
Thursday,May 25, 2023
j 8 4 2 SM www.catawbacountync.gov
PAYOR: Tasty Pizza Hut
Tasty Pizza Hut
PAYMENTS
TRANSACTION NUMBER: TRC-64840504-25-05-2023
PAYMENT DATE: 05/25/2023
PAYMENT TYPE: DV
INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT
05-23-422787 110-580200-663000 Temporary Food Establishment ($75.00)
Fee
TOTAL PAYMENTS: ($75.00)
FL1-05-2023-195800
CASE TYPE: Food&Lodging Institutions WORK CLASS: 73-Temporary Food Fstablishmen
SITE ADDRESS: 3130 HWY 70 SE,HICKORY NC 28658
Applicant TASTY PIZZA HUT, 1625 CLEMENT BLVD NW,HICKORY NC 28601
C:8283013604
**NO PEOPLESOFT ACCOUNT ASSIGNED**
receipt 05/25/2023 12:24 Pat:.I of I
' (30 a
Application for Temporary Food Establishment Permit
(To be completed for each booth at least 2 weeks prior to the event)
'ri f,, pi piir.s ` Please run1e rherks payable so Catawbo County fnrironmentol Health
c a t aw b a county Mini w:(orn.siaa County Environmental Health, PO Box 389,Newton, NC 28 58
public health ` h c�O�u,
...., ,,r�x• ,r„,. —Ail parts of this application must be filled out before turning in
Establishment Name l C:l`s�t t il.'r'Cx i� Cti ^65 " )0-)3 -Lq 560o
11ff ID p?Uii(l_ I310q
Operator/Owner Name w��� �t � (� � ( ^ �` ' , (,,f
Mailing Address 1 �c `,-.1 C(C l?'lerl.t" 11 l W 111 A t t i aI)Al,-
Telephone (daytime) ' ir.,i- I- 2b(.4 (evening) ?II- 361 -3106q
"' E-mail Address: h'1ax 1 - 1
Name of Event/festival/Carnival;etc. 141 r, (til 121 A Dl'.� l G' �� c
Dates & Times of Operation M e� l l.i P�- [ 11 an — ` p Y1'1
Event Location O 1(LAI I OILY , [41Al2 s Setup Completion Date& Time Ma, Le 1-pen
Signature of applicant _/rY)1kPi Q p A z
Menu: Attach menu or list all food items to be prepared or served.
_tr (Li_g pet in fizza
Al!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
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Foods Prepared and Cooked Of site:
Nome of Permitted Establishment 1-C..S -t Puri-- 1-4LA--+
NC DENR Establishment ID# e c.(.._ c)q 1 Lr I
Establishment Owner/Manager Y L ('. D►_ I O'
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Establishment Address I LP G-S Lie me r\f �I V(1 lV �l c I 1 C r.....brilc
Establishment telephone# 8 3°1 b ` R- -1tA
In the table below list all foods prepared in the permitted establishment and (heck all procedures performed there.
Foods o c o v
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Sources of all meat, poultry, seafood and shellfish: p1 ,. . .
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Hot fy� ad x,
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Method of storing and disposing of wastewater: ,tt
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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. . .
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g A CATAWBA COUNTY
100A SOUTHWEST BLVD
H ,� NEWTON,NORTH CAROLINA 28658 RECEIPT
0 1.Th PHONE:828.465.8399
,� 41 Tuesday,May 16,2023
18 2 sM www.catawbacountync.gov
PAYOR: Tasty Pizza Hut
Tasty Pizza Hut
PAYMENTS
TRANSACTION NUMBER: TRC-64201919-16-05-2023
PAYMENT DATE: 05/16/2023
PAYMENT TYPE: Credit Card
INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT
05-23-422787 110-580200-663000 Temporary Food Establishment $75.00
Fee
TOTAL PAYMENTS: $75.00
FL1-05-2023-195800 _......
CASE TYPE: Food&Lodging Institutions WORK CLASS: 73-Temporary Food Establishmen
SITE ADDRESS: 3130 HWY 70 SE,I IICKORY NC 28658
Applicant 'PASTY PIZZA HUT, 1625 CLEMENT 13I,VD NW,HICKORY NC 28601
C:8283013604
**NO PEOPLESOFT ACCOUNT ASSIGNED**
receipt 05/16/2023 16:05 Page 1 of 1