HomeMy WebLinkAboutEHPR-06-2023-44699.tif CATAWBACatawba County Public Health Department
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Division of Environmental Health
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FOOD ESTABLISHMENT PLAN REVIEW APPLICATION FOR OWNERSHIP CHANGE
(Note that if t/u'rstuhlishment has been closed for over one year then applicant must fill nut short limn instead of this form)
Name of Existing Establishment: Grace Convenience of Claremont,LLC d/b/a 7-Eleven#36071A
Name of New Establishment Unless the Same: 7-Eleven#36071J
Establishment's Address: 3137 N.Oxford Street
City: Claremont Zip Code: 28610
New Owner's Name: 7-Eleven,Inc.
Mailing Address: Attn Licensing,PO Box 139044 City: Dallas,TX Zip Code: 75313
Phone Number: ( 828 )—( 459 - 2758 ) Fax: ( )— -
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Please Enclose the Following Documents
• Proposed menu items (including seasonal variations in the menu).
• Manufacturer specification sheets for each piece of equipment that may be added or replaced.
• Plan of facility drawn to scale(min '/"= I')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
Sun 24/7 Mon Tue Wed Thu Fri Sat
Number of Seats 0
Number of Staff 3 (Maximum per shift)
Facility Total Sq. Ft.
Projected Number of Meals to be Served: (Approximate number)
Breakfast 0 Lunch 0 Dinner 0
Projected Start Date: 06/14/2023
Type of Service (Check all that apply)
Sit Down Meals
Take Out
Caterer
Mobile Food Unit
Push Cart
Single
Service Utensil Only
Multi- seZ] tltt ervice Only 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 I5A
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
Bar
Food Storage N/A w^ CHANGES I Dry Storage
Restrooms
Garbage&Can Wash Areas
Wait Station Areas
Other . _
Other _.
FOOD PREPARATION REVIEW
Check categories of Potentially Hazardous Food (PHF) to be handled prepared and served. 01L 9
CATEGORY Yes No
Thin meats, poultry, fish,eggs(hamburgers, chicken breast, fish filet,etc.)
Thick meats,whole poultry(whole roasts,pork,chicken, meat loaf,etc.)
Hot processed foods(soups, stews,chowders,casseroles)
Bakery goods(pies,custards,creams)Other:
PLEASE CHECK Box FOR THE FOLLOWING QUESTIONS
FOOL)SUPPLIES
1. Are all food supplies from inspected and approved sources? - No
COLD STORAGE
2. Are adequate and approved freezer and refrigeration available to store frozen foods at 0°F and
below, and refrigerated foods at 45° F (7°C)and below? CO No
Provide the method used to calculate cold storage requirements:
Provide total footage of space dedicated to walk-in cold storage 04 0
Provide total footage of space dedicated to reach-in cold storage
3. Will raw meats, poultry and seafood be stored in the same refrigerators and freezer with,
cooked/ready-to-eat foods? Yes Nh
If yes,how will cross-contamination be prevented?
4. Does each refrigerator/freezer have a thermometer. Ye No
Number of refrigeration units: p Number of freezer units:
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 I Baked Goods
Refrigeration
Running Water less than 70°F(21°C)
Cooked Frozen(indicate wt.lbs.)
Microwave
Other(describe):
3
•
COOKING PROCESS
Item#1 -Will food product thermometers(0°-212°F)be used to m ure final cooking/reheating
temperatures of PI-IF(potentially hazardous food)? 'es 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 sec)
Eggs 145° F (15 sec) * reheating PHF 165°F(15 sec)
Item#2-Hot Holding
How will hot PHF (potentially hazardous food)be maintained at 135° P (57" C)or above during holding
for service? indicate type and number of hot holding units.
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Item #3-Cold Holding
How will cold PHF(potentially hazardous food)be maintained at 45°F(7° C)or below during holding
for service? Indicate type and number of cold holding units.
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Item #4-Cooling
Please indicate by checking the appropriate box how PHF (potentially hazardous food)will be cooled to
45°F(7°C)within 6 hours(135°F to 70°F in 2 hours and 70°F to 45° F in 4 hours).
Cooling Process Thick llcats Thin Meats Fish Seafood Poultry Products Baked Goods
__
Shallow Pans
Ice Baths ------- �
Rapid Chill
n [ p.
Other(describe):
FOOD PREPARATION
1. Please list categories of food prepared more than 12 hours in advance of service.
4
i
2. Will disposable gloves and/or utensils and/or food grade paper be used to minimize handling of
ready-to-eat foods? es No
3. Is there an established City to exclude or restrict food workers who are sick or have infected
cuts and lesions? Yes No
Please describe procedure:
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4. 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:
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5. How will ingredients for cold ready-to-eat foods such as tuna,mayonnaise and eggs for salads
and sandwiches he pre-chilled before mixed and/or assembled
ICl
6. 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:
THE FOLLOWING 4 QUESTIONS DEAL WITH 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.)
ur company has food preparation procedures already developed,these can be submitted as part of
the plan 'ew approval process.
1. Produce Preparation-Procedures
a. Will produce be washed oriits rior to use? Yes No
b. Is there an approved location used for ing or rinsing produce? Yes No
c. W ill it be used for other operations? - Yes No
Please indicate location of produce washing equipment and describ rocedures. Include time of day
and frequency for washing or rinsing the produce at this location: ��
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:
Seafood Pre aration Procedures
a. ' 1 seafood be washed or rinsed prior to use? Yes No
b. Is them. approved location used for washing or rinsing seafood? Yes No
c. Will it be use for other operations? Yes No
Please indicate location of • food washing equipment and describe the procedures. Include time of day
and frequency for washing or ri • g the seafood at this location:
Please describe the seafood preparation procedures ark 'ndicatc location of equipment to support this
operation. The preparation procedure should include dish •roposed menu items) in which the seafood
will be used,and should include time of day and frequency of p • .aration for the seafood at this
location:
'3. Poultry Preparation Procedures
a. Wrll`pultry be washed or rinsed prior to use? Yes No
h. Is there U-n tppr vcd location used for washing or rinsing poultry? Yes No
c. Will it be used fora operations? Yes No
Please indicate location of poultry washin equipment and describe the procedures. Include time of day
and frequency for washing or rinsing the sea o t this location:
Please describe the poultry preparation procedures and indicate location off a Went to support this
operation. The preparation procedure should include dishes(proposed menu items ' hich the poultry
will be used.and should include time of day and frequency of preparation for the poultry a ' location:
4._I,'ork and/or Red Meat Preparation Procedures
a. Will p rTc`and-r eats be washed or rinsed prior to use? Yes No
b. Is there an approved location us • hing or rinsing pork and red meats? Yes No
c. Will it be used for other operations? - Yes No
6 _'____ —
•
.
P lese-i dicate location of seafood washing equipment and describe the procedures. Include time of day
and frequene washing or rinsing the seafood at this location:
Please describe the pork and red meats preparation prvedL►reess 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 a ad frequency of preparation
for the pork and red meats at this location:
DESIGN INFORMATION
I. 1)RY GOODS STORAGE
1. Is appropriate dry = d storage space provided for based upon menu, meals and frequency of
deliveries? es No
Provide information on the frequency of deliveries and the expected gross volume that is to be
delivered each time.
II. WATER SUPPLY
I. Please check one: Is water supply a well (community)? Yes (N Municipal?4, No if
the Water supply is other than a Municipal supply, it will he required to be registered with
Public Water Supply.
2. If water supply is from a Community Water Supply system is it registered and approved
public water supply? Yes No
If yes,please attach copy of written approval and/or permit. }
3. Is ice made on premises or purchased commercially? Yes .
Please specify:
If made on premised than specification for the ice machine will need to be provided. Describe
provision for ice scoop storage:
III DUMPSTER
4. Will a dumpster he used? No NiA
7
Number 2 Size Frequency of Pickup Contractor
Service:
5. Will the dumpster be cleaned on site'? Yes49
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.
6. Is the dumpster to be cleaned by an off site contracted cleaning service? Yes o If yes,
please provide name and address of the firm contracted for this service.
Name:
Mailing Address:
City: State: Zip Code:
Telephone: ( )-( - ) Fax: ( )-( - )
7. Will trash containers be stored outside? Yes No
If yes, please describe location:
8. Type and location of waste cooking grease storage receptacle 9. Is there an area to store
recycled containers? Yes No
Describe:
10. Location and size of grease trap
X. SEWAGE DISPOSAL
1. Is building connected to a municipal sewer? S No
2. If no, is private disposal system approved(septic system)? Yes No Pending If yes,
please attach a copy of the written approval and/or permit.
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STATEMENT: 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.
Signature( a14161L— -(5)"7Th
Owner(s)
or Responsible Representative(s)
Date: 06,fo-/a3
8
IL$� • CATAWBA COUNTY
' 100A SOUTI IwEsT BLVD
• NEWTON,NORTH CAROLINA 28658 RECEIPT
‘•'-‘4
° /,S, PIIONE: 828.465.8399
Wednesday,June 21,2023
I8 4'Z sM www.catawbacountync.gov
PAYOR:
Robinson PA,Gray
PAYMENTS
TRANSACTION NUMBER: TRC-66800466-2 1-06-2023
PAYMENT DATE: 06/21/2023
PAYMENT TYPE: Credit Card
307010551
INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT
06-23-424354 110-580200-663000 Food and Lodging Review Fee $75.00
TOTAL PAYMENTS: $75.00
EHPR-06-2023-44699
CASE TYPE: Environmental health Plan Review WORK CLASS: Other FI,1
SITE ADDRESS: 3137 N OXFORD ST,CLAREMONT NC 28610
Applicant 7-ELEVEN INC,PO BOX 139044, DALLAS TX 75313
B:8505779090
Paid By GRAY ROBINSON PA,301 E PINE ST,ORLANDO FL 32801
**NO PEOPLESOFTACCOUNTASSIGNED**
receipt 06/21/2023 08:27 Page 1 of 1