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Home My WebLink AboutFLI-10-2023-205766.tif ( 1 Application for Temporary Food Establishment Permit (To be completed for each booth at least 2 weeks prior to the event) c a t aw h a county $75 fee applies I Please make checks payable to Catawba County Environmental Health Mail to:Catawba County Environmental Health, PO Box 389,Newton, NC 28658 public health KARIM6. LIVING. RETTII. **All parts of this application must be filled out before turning in'" BasedBossFi!ib- 03 -a9571v1) Establishment Name Plant (i) ac673139i Operator/Owner Name Ashley Pope Mailing Address 221 1st Ave NW Suite 110 Hickory NC 28601 Telephone (daytime) 5109178735 (evening) E-mail Address: plantbasedbossllc@gmail.com Name of Event/Festival/Carnival;etc. Oktoberfest Dates& Times of Operation October 13th 12-11 , 14th 10-11, 15th 12-5 Event Location Hickory Setup C !alien Date & Time October 13th 9 am Signature of applicant Menu: Attach menu or list all food items to be prepared or served. Beyond bratwurst with mustard and sourkraut, beyond bratwurst with beer cheese and sour kraut, German nachos ppwith beyond bratwurst� beer cheese, r iico de All foods sold at this Temporary food Establishmd ent must be prepared andtcooked attthe permitted site exceptfoods 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 3 E - 0 0 0 0 0 0 u Q V V V Z Z Z a s Beyond bratwufrs❑ ❑ El ❑ ❑ ❑ ® ❑ Beer cheese ❑ ❑ ❑ ❑ ❑ ❑ ® ❑ Sour kraut ❑ El ❑ ❑ ® ❑ ❑ ❑ Pretzel bites ❑ ❑ ❑ ❑ _ ❑ ❑ ® ❑ Pico de gallo ❑ ❑ ❑ ❑ ® ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 0 ❑ ❑ ❑ ❑ ❑ ❑ 0 ❑ 0 ❑ 0 0 ❑ 0 Foods Prepared and Cooked Offsite: Name of Permitted Establishment Plant Based Boss NC DENR Establishment ID# Establishment Owner/Manager Ashley Pope / I s s a Geran Establishment Address 221 1st Ave NW Suite 110 Hickory NC 28601 Establishment telephone# 8289625443 In the table below list all foods prepared in the permitted establishment and check all procedures performed there. —1 Foods tV 01 �a, V V V Z �C Z Z Q Beyond bratwur Sour kraut Pico de gallo _ Beer cheese Pretzel bites Sources of all meat, poultry, seafood and shellfish: • N/A • Method of storing and disposing of wastewater: Plumbing on site I 1 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. Back Cpmnerciai I _.J -_ Sauce � , Avant�C t Steamer Kttle Cook r oo er Cold hold ng War a ar erI f -- _ I Hand (Igloo with hot water ashing and hand soap) tion -Pi -#-}.boar:---_. Me h 3 1 Wash. Te t cOilin . ---- __Rinse_ basin Sanlitize.� Cry W er,' so rce. 1 Was t---r---- I I 1 hing i 1 -- 1 T Front All booths must comply with the requirements listed in 15A NCAC 18a .2665-.2669. A copy of this document is available at http://www.catawbacountync.qov/phealth/ehmain.asp. A brochure explaining the rules and requirements in detail is available on the Catawba County Environmental Health website at http://www.catawbacountync.qov/EnvironmentalHealth/ TempFood.asp. 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 2 weeks 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 ENVIRONMENTAL HEALTH Catawba County Government Center 125 Government Drive I P.O.Box 389 Newton,NC 28658 Phone:(828)465-8270 I Fax:(828)465-8276 Email:EHAdinin@CatawbaCnuntyNC.gov CATAWBA COUNTY �" : /i'e ( 100A SOUTHWEST BLVD CNEWTON,NORTH CAROLINA 28658 RECEIPT V O i,4r PHONE:828.465.8399 Monday,October 2,2023 1$4 2 5M www.catawbacountync.gov PAYOR: Plant Based Boss Plant Based Boss(Pope,Ashley) PAYMENTS TRANSACTION NUMBER: TRC-74491634-02-10-2023 PAYMENT DATE: 10/02/2023 PAYMENT TYPE: Credit Card 311466365 INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT 10-23-428760 110-580200-663000 Temporary Food Establishment $75.00 Fee TOTAL PAYMENTS: $75.00 FLI-10-2023-205766 CASE TYPE: Food&Lodging Institutions WORK CLASS: 73-Temporary Food Establishmen SITE ADDRESS: 280 UNION SQUARE,HICKORY NC 28601 Applicant PLANT BASED BOSS,221 1ST AVE NW 110,HICKORY NC 28601 C:5109178735 PLANTBASEDBOSSLLC@GMAIL.COM **NO PEOPLESOFT ACCOUNT ASSIGNED** receipt 10/02/2023 10:47 Page 1 of 1