HomeMy WebLinkAboutFLI-10-2023-205807.TIF ,
‘7 Application for Temporary Food Establishment Permit
` (To be completed for each booth at least 2 weeks prior to the event)
S 5 fee applies I Please make checks payable to Catawba County Environiiieiitnl Healiii
catawba county ma Jo:Cntmvlrn County fi,viionmei lni Neat, PO Box 389,fewtoc, NC 21368
public health _
BILKING.LIKING.BETTER. **All parts of this application must be filled out before tujjai`g in" inC�3 _ 05W�
L
ID- ao\g'13 i joo
Establishment Name '•J{(���-e'kr C-V) C c C v e v-, \ CY' -* t t e CG4 �`�ti
Operator/Owner Name C v \-0 '5 Y\7\C (C-I ...-)\
\ `‘ _ \\ 'WC DE6.o)
MailingAddress_ ( � ��\ � v e � �J \ C��c�r� ,_
evenin aE G 7 9 13
Telephone (dayfime) `'1� pis 7 -7 � �� (evening)
E-mail Address: G )v C1Z YNIC C.G.E}\ r'`l 6 G. YC t\ . C C:u''
Natme of Event/Festival/Carnival;etc. PO-\ t c.,Y,I C LA-u ,,,,- C\\-'
Dares& Times of Operation On V N3V1-- 1,-k a\-- ' �})-- .,C___))3 3
Event Location ,\-. •• 'r`� I Setup Completion Date & Time C ► lcb� -4 15 2 }2
Signature of applicar •
Menu: Attach menu or ist all food items to be prepared or served.
l 2 2 C=c 1 1 Cj
'�,�-E5v-cl-, c v. t-,.,--'�.) C
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 FICAC 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.
O o 0
r.—. J . v CX = e. a_
1
a2-2c / ❑ _ � ❑ ❑ LJ0 ❑ ❑ ❑ ❑ —1 —
q K4)-5 ❑ ❑ ❑ ❑ ❑ ❑
0 0 0 0 0 0 0 0
❑ El ❑ ❑ ___ ❑ El ❑ ❑
❑ 0 ❑ 0 0 n ❑ I—
❑ - n ❑ ❑ n H _
io-aa
(!r.,`i,a 40