HomeMy WebLinkAboutFLI-10-2023-206004.TIF (4 Application for Temporary Food Establishment Permit
(To be completed for each booth at least 2 weeks prior to the event)
$1s fee applies I Please make(becks payable to Catawba County Environmental Health
c a t aw b a county Mail to:Catawba County Environmental Health,PO Box 389,Newton,NC 28658
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"All parts of this application must be filled out before turning in"
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Establishment Name i7tth{ Plz zu FduO' U. C ir.' ` -n_01 ') 1 •U S
Operator/Owner Name Mal. Ure i /Ai LatIUIS
Mailing Address L I a 5 Cl e t1Pk.- 6(Vd ki Ili iliCitorq Iv e
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Telephone(daytime) S1 01-3.0g4 Alt- 39b-R411((evening) .5a4'K-G
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Name of Event/Festival/Carnival;etc. 0 4�i�/ �l'R..ai
Dates & Times of Operation Oc /3 , )1-1 ifUt c (,51-IL
Event Location b01.10ritzux R I C,Y�r ti. Setup Completion Date&Time CC-1- ) Z_' ' ,5pm
Signature of applicant litactest Co
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Menu: Attach menu or list all food items to be prepared or served.
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AN foods sold at this Temporary tool Establishment must be prepared and cooked at the permitted site except foods prepared in another
establishment permitted under 15A NCAC 18A.2659. 1
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 .,u — 1 I o
0 0 —. - .p.'0*----
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� a �+ J � = ag xx a �
__ ❑ ❑ ❑ ❑ 0 ❑ ❑ o
❑ p 0 ❑ E E 0 0
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