HomeMy WebLinkAboutFLI-07-2023-201060.tifl
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Eg.�„ Application for Temporary Food Establishment Permit
�. (To be completed for each booth)
:4 : *.1 $75.00 Fee Applies
Please make check payable to Catawba County Environmental Health
j 8 4 2 ski Application
to Catawba County Environmental Health,PO Box 389,Newton,NC 28658
Establishment Name Bohemian Cattle Co. RI - 07- )0)3 "X iD(Pb
Operator Name Colby Brownlee Executive Chef I 0 c v 18 7313'1
Mailing Address 2548 Perry View Lane Denver NC 28037
Telephone (day #) 704-989-3138(Cameron Cane Owner)(after hours) 704-989-3138 Location of event Bohemian Cattle Co. Sherrills Ford NC S f 1 c6 lsIai (Dinnnt- Rd
Name of Event/Festival/Carnival; etc. Grand Opening
August 2-6;August 9-13.August 16-20,August 23.27.August 30-Sept 4;Sept 6-Sept 10.Sept 13-Sept 17.Sept 20-Sept 24,Sept 27-Oct 1.Oct 4-Oct 8.Oct 11-Oct 15
Dates &Times of Operation8-0ct22
Please Indicate Setup Completion Time 3hrs
Signature of applicant: C56........ Cameron Cane
Menu: Attach menu or list all food items to be prepared or served.
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 .2602.
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 3 `� ti :~ cl) c o cz"
,� = 0 0 co (1..) O O O
u
czs
F-4 U < U U Ux ix xx a. a.
Brisket X X X X
Pork Shoulder X X X X
Pork Ribs . X X
Half Chicken X X X
Pulled Chicken X X X X
Tri Tip - X X X }�
X X
X ,
Steaks I X X X X
Foods Prepared and Cooked Offsite:
Name of Permitted Establishment:
NC DENR Establishment ID#
N / A
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.
to Q b�q
Foods 3 `ri a a o
b b i
CA 0 a) o 0 0 csEi
U Ix x x a. a
N / A
List sources of all meat, poultry, seafood and shellfish:
Performance Food Group
Inland Seafood
State method of storing and disposing of wastewater:
Septic Field and holding tanks
Temporary Food Establishment
Draw to scale, identifying and describing all equipment, including handwash 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 unit
All booths must comply with the requirements listed in 15A NCAC 18a .2635. A copy of this document is
available at http://www.deh.enr.state.nc.us/ehs/26.htm.
A brochure explaining the rules and requirements in detail is available on the Catawba County Environmental
Health website. 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 Department
Environmental Health Division
100-A Southwest Boulevard
P.O. Box 389
Newton,NC 28658
(828)465-8270
(828)465-8276(fax)
(828)465-8200(TDD)
Smoked BBQ Meats
-BRISKET(Cooked to 2001
-Pulled Pork(Cooked to 200°)
-St Louis Ribs [Back Porch Ribs] (Cooked to 185°)
-Tri Tip Steak (Cooked to 155°)
-Sausage (Cooked to 165°)
-Smoked or Crispy Jumbo Smoked Wings
(Cooked to 172°)
-Half Chicken (Cooked to 168°)
-Pulled chicken (Reheated to 165°)
-Burnt Ends (Reheated 170+°)
Raw Meat Case
-Rotating Steaks
-Rotating Fish
-Raw House Made Sausages
-Shrimp
-Scallops
-Ground Beef
-Burger Patties
Tacos
-Grilled Shrimp Taco
-Queso Birria Taco
-Sausage Tortilla Wrap
Sandwiches
-Blackened Shrimp Po'Boy
-Smoked House Burger
-Meat Sweat Sandwich
-Brisket Cheesesteak
Sharables
-Loaded Queso
-Brisket Piccadilly Tostadas
-Nachos(Meat Choice... Pulled Meats)
-2 or 4 Ranch Hand Sliders (Meat Choice)
-Smokehouse Mac n Cheese (Meat Choice)
Sides..$6.00
-Campfire Baked Beans
-Cilantro Lime Slaw
-Green Beans
-Barbequed Collards
-Grilled Asparagus
-Garlic Chive Mashed Potatoes
-Refried Beans
-Regular Mac n Cheese
(ids Menu 1
Grilled Cheese
-Kids Regular Mac , ,
.-Kids Portion Pulled Pork
-Kids Portioh Pulled Chicken i •
-Kids Quesadilla
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y IiI;'il,k !f iifse?•t laure:e�ir►dl s.o1,40 . rlet.rribri 1il ,It or,'Wrallll 2nce(*ding eurdac'es of ai a roil
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411?)A Case 1a 11'I':I.l.-l14-2023-I92896
It ��� ('AI'AWI3A (J)UN'I'Y IINAI:III I)I',I'AR'I'MENT
Qt a.�9 ,� I•:nvlrmnmental IIcalth Section
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WATER SAMPLE FIELD I) REPORT
^�-~ Applicant ('ANP.SIAN TI IIF(tR1'II(II.I)IN(iS 1.1 C.25-18 1'1'.RRI'VIliW I.N,DFNVI R ill'2su.i7
(':70•I9)t93I38 (-CANEto;d.(iM1AI ..COM
Site Address: $17F Island Point RI),Shcrrills Ford N( 2h1(73
Name of Subdivision: CAROLINA CENTERS LLC
Parcel Number: 461 R(11 1 93(1 17
Driving Directions Shcrrills Ford Rd,right Island Point Rd,on left
Sample Collected b}': W I^� Dalefl'ime Sampled: p7/�Lt/r'1 3 lU • 415 Ill
Sant piing Point: 5-
6,►v- L
Is well head accessible? 1'r.s No Reason lily inaeeessibilit\
Well New or Existing? New bxistin . _,_ __
Type of Well: Drilled Bored 1 land Dug _ Punch
Does well meet adequate construction standards from what can be observed: ✓Yes _No
Itents of non-compliance: Evidence()I'improper_routing or no;routing
Well does not meet a required setback(comment.)
Improperly constructed sanitary well seal
Well head not term at • 12"above :finished grade
Well head missing vent
Well head does ilia have a threadless tap
14'cll missing identification plate or hump tag
Wire conduit opening not sealed
()thcr(comment)
('omment:
1,,, n klreporl a/..al 210.i I,.2e Page I ui
.1.-04-2023-i 02m,
t
(.'ATAWBA (1.)UNTY FIEALTI I DEPAIZTMEIN"(1
Environmental I Icalth Section
ty'y
\\ATER SANIPLE TEST IIESIULTS
Applicant 1111.010' 11ml WNW;1.I.C,254N l'ERRYVIEWI.N.1)ENVII.R NC 's017
C.70.1989.1}38 CCAN1 .16:frt.iMA11..CONI
!,ite Address: XI7X Island Point RI),Sherrills Ford NC 28673
Namc ol-Subdivision: CAROL INA CENTERS LL.0
Parcel Number: 46 I X011931)17
lab Culiform Analysis Results: Total Coliforms: OPeill
Feca! I- t ( jfl
No Collection Date t her.1(1 hours old
Insalid Results:
I:\eessivc turbidity 1..xcessivc Chlorine
I ib Accident
TO 9117 I vlir:OH
Lab Tech Initials Date/Time Received 01134411?) CtLi Date/Time Completed
: v
(""' E D
Environmental Health
4'A CATAWBA COUNTY
100A SOUTHWEST BLVD
i7 ` NEWTON,NORTH CAROLINA 28658 RECEIPT
U� g4:P PHONE:828.465.8399
'r4P Thursday,July 27, 2023
18 4 2 sm www.catawbacountync.gov
PAYOR:
Cane,Sheila
PAYMENTS
TRANSACTION NUMBER: TRC-69472154-27-07-2023
PAYMENT DATE: 07/27/2023
PAYMENT TYPE: Credit Card
308570637
INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT
07-23-425962 110-580200-663000 Temporary Food Establishment S75.00
Fee
TOTAL PAYMENTS: $75.00
FLI-07-2023-201060
CASE TYPE: Food&Lodging Institutions WORK CLASS: 73-Temporary Food Establishmen
SITE ADDRESS: 8178 ISLAND POINT RD,SHERRILLS FORD NC 28673
Applicant *CANESIAN THEORY HOLDINGS LLC,3630 TRYCLAN DR,CHARLOTTE NC 28217-1330
B:7049893138 CCANE@CSCORY.COM
Paid By SHEILA CANE,2548 PERRY VIEW LN,DENVER NC 28037
**NO PEOPLESOFT ACCOUNT ASSIGNED**
receipt 07/27/2023 10:11 Page I of I