HomeMy WebLinkAboutFLI-10-2023-206218.TIF f
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Application for Temporary Food Establishment Permit
(To be completed for each booth at least 2 weeks prior to the event)
Catawba 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
MAKING. LIVING. BETTER. **All parts of this application must be filled out before turning in**
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Establishment Name Aaa be.-If
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Operator/Owner Name 11:2"'W - ✓"vt-cV
Mailing Address laog 02ne✓MA. /04/ /7//Q11a/det / / e c>1-86.57
Telephone (daytime) ela- 6/3-- 9f 5- (evening)
E-mail Address: /fJ_J S441". 0e7•
Name of Event/Festival/Carnival;etc. IA, /l/aa ye4r
Dates& Times of Operation //— g 3 ----- /1-9 , -.20a-3 e.A.ki — L. P'
Event Location 3S012 /oe /'111/e0 Setup Completion Date & Time ii— 2'2 IP cZ= /"4 1
Signature of applicant11-1-401- 04-ty
Menu: Attach menu or list all food items� to be prepared or served. / /
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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 1SA 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 N � ti 01&31--
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Foods Prepared and Cooked Offsite:
Name of Permitted Establishment
NC DENR Establishment ID#
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.
Foods 3 E -� g
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Sources of all meat, poultry, seafood and shellfish: /
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Method of storing and disposing of wastewater:
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/7s�/'es— -40 ha/ 7�� c p/ Cis �/9// �'�sfc u,a- .
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