HomeMy WebLinkAboutFLI-10-2023-206003.TIF PIN Application for Temporary Food Establishment Permit
' (To be completed for each booth at least 2 weeks prior to the event)
$75 lcr opplin ( Pkase nwakv rhttks payable to Cataw6u County€nviranmenfal Health
cat a w b a county Mail tur Catawba County fnvironmrntul lluekh, PO Box 389, Newton,NC 28658
"All pads of this application must be tilled out before turning in"
iLt - (0 -.)CA. -- u(c003
Establishment Name 1 aSf t/ Pie e ea- [ILA , L.L_ I `) ?QO(� 1 ito)
Operator/Owner Name Maelf. (J °AJ /it I IL �iAS
vd (U 1-licvo ( ?e
Moiling Address L as �.l ekt1t�t..l �( _ , J�✓
Telephone (daytime) SZ8 -.it3)`3l,Q4 Ei .- - C)b-13/1c{(evening) 6G vii
E-mail Addsrs,: robe-1 a.g-t1ph. Com-
Name of Event/Festival/Carnival;etc. OV-101 fcC. -
Dotes& Times of Operation (90k 13 , (r-4 a-1kt d l,5
Event Location l}WY\ttwn R i Ct{.0 Setup Completion Date&Time ON 12-Th .cpYY)
Signature of applicant a..e ei VO,P I
Menu: Attach menu or list all food items to be prepared or served.
c-Prack. by 44-te. 51tct�
-1 t.z zra. to LL W-rz Ve PiDo lLe i -hDA.r1 Ln 5,k in a., hot-had 0 air)4 tak .
1/1/ u1t th Toties b`1 - 1iC.2 Un paperPtO.KS
Ail foods sofd at this Temporary food Establishment must be prepared and cooked at sire 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 3 3 E .24 _ a 0
.= ._ '�
uQ tr 0 � _ 0 = = c� O.
V&A- D ❑ ❑ 0 0.-- 0 JO
IZI
0 F J 0 0 0 0 0 0
C� _ [❑ 0 0 0 0 0 0
0 D ❑ ❑ ❑ 0 ❑ ❑
0 0 0 0 El 0 .
(+ CI ElD
.�.. ,�,{. Sit.A.
n^g �r M f �� i*a y,y
R¢ Y V ;
�' �:S N '. 53' 'C R aw ( : },' d �,,, rhs.3 7 -{et er-, r,"s� . °
t 4 ;q�W : {_:" '`y,.ff S tin ''�
y, _ _:P. RtaL .. .....,.Ft:z,al_.,la. L4rz,".,x.r �C' ,