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Home My WebLink AboutEHPR-08-2014-19715.TIF LUPQ-0-Zo)q- R7/5 EN\1<,,A-v1,6- C)L-Niz- 4.,..A ....), C-l-i-t‘v,-.1:-,if S ' - Catawba County Environmental Health F AIL Contact Information for Plan Review ill :) 100A Southwest Boulevard, Newton, NC 28658 ir (828) 465-8270 phone (828) 465-8276 fax FLI Case# PLN Case# Property Location Property ID# * - - - Street Address * Co6!d /4 Loy Ile kiwi-6 City * QpIAQ\ 4r 1 kr Zip * ia,83(0i . Business Name: * C Nd8.'S IPA t. ,c," C e,`) 1 Mailing Address * C 1a 141,d7 1 WoiiJ-) 1 Address 2 * City * 1.0 Javer ; Q Zip * a.3 Co )3 Phone * A - caSto — zap? Owner Name 8 K 6/V • N.1 semi Owner Mailing Address a i '76 RIB o L. ,ex k ?,i 4, gn Address2 City _A, 1_`.)' Q NC, Zip e.a g"/ Phone Q,- �, -- t ?a 7 I j 7 Architect Contact Address Address 2 City Zip Phone Contractor Contact Address Address 2 City Zip Phone Contact Information Sheet and$200 fee required to begin plan review process Complete and return Food Establishment Application * Required field Applicant Signature : Date O `7'aa2 `ot • • ' f Catawba County Public Health Department .0101 ' Division of Environmental Health FOOD ESTABLISHMENT PLAN REVIEW APPLICATION For submission with full set of signed and sealed plans produced by an architect or engineer. Type of Construction: NEW REMODEL CONVERSION County in which Located: Name of Establishment: Establishment's Address: City: Zip Code: Phone if available: ( )—( - ) Fax: ( )— I have submitted plans/application to the following: [Please note date.phone number and contact person on application line) Plumbing A)/a Contact Person Phone Number ( ) Electrical N /�¢ Contact Person Phone Number ( ) Building / A Contact Person Phone Number ( )— Hours of Operation / Sun Mon Tue V Wed Thu / Fri / Sat Number of Seats '71' Number of Staff (Maximum per shift) Facility Total Sq. Ft. Projected Number of Meals to be Served: (Approximate number) Breakfast lJ)p Lunch 46 Dinner C1C) - iox Projected Start Date of Construction ) ll4- Projected Completion Date of Project OP' 1 Type of Service (Check all that apply) Sit Down Meals Take Out v/ Caterer Mobile Food Unit Push Cart Limited Food Service Temporary Food Stand Single Service Utensil Only Multi-Use Utensil Service Only Both Multi-Use and Single Service Utensils Other Please Enclose the Following Documents • Proposed menu items (including seasonal variations in the menu). • Manufacturer specification sheets for each piece of equipment shown on plans. • Site plan showing location of business in building, location of building on site including alleys, streets and location of any outside facility(dumpster, walk-ins, etc.). • Plan of facility drawn to scale showing location of equipment,plumbing, electrical service and mechanical ventilation, including location of all electrical panels. 2 ITEMS THAT NEED TO BE ADDRESSED 1. Information plans should include;the proposed menu, seating capacity,projected daily meal volume for food service operation. 2. Adequate rapid cooling including ice baths and refrigeration, and hot-holding facilities for potentially hazardous food(PHF) should be clearly designated on the plan. 3. When menu dictates, separate food preparation sinks should be labeled and located to preclude contamination and cross-contamination of raw and ready to eat foods. 4. Auxiliary areas such as storage rooms, garbage rooms, toilets,basements and/or cellars used for storage or food preparation should be represented on the plan. 5. Insure that all food service/kitchen equipment is National Sanitation Foundation International (NSF) listed, Underwriters Laboratories Inc., Classified for Sanitation or if not NSF or UL listed/classified,be constructed to meet NSF standards as specified according to 15A NCAC 18A .2600, Rule .2617 paragraph (d).\ 6. As specified according to 15A NCAC 18A .2600, Rule .2632 "Storage Spaces". All items stored in rooms where food or single-service items are stored shall be at least 12 in. (30.48 cm.)above the floor when placed on stationary storage units or 6 in. (15.24 cm.)above the floor when placed on portable storage units or otherwise arranged so as to permit thorough cleaning. 3 FOOD PREPARATION REVIEW Check categories of Potentially Hazardous Food(PHF)to be handled prepared and served. CATEGORY Yes No Thin meats,poultry, fish, eggs (hamburgers, chicken breast, fish filet, etc.) Thick meats,whole poultry(whole roasts,pork,chicken,meat loaf, etc.) Hot processed foods (soups, stews,chowders,casseroles) Bakery goods(pies, custards, creams) Other: PLEASE CHECK Box FOR THE FOLLOWING QUESTIONS FOOD SUPPLIES 1. Are all food supplies from inspected and approved sources? Yes . No COLD STORAGE 2. Are adequate and approved freezer and refrigeration available to store frozen foods at 0°F and below, and refrigerated foods at 45°F (7° C) and below? Yes No Provide the method used to calculate cold storage requirements: Provide total footage of space dedicated to walk-in cold storage Provide total footage of space dedicated to reach-in cold storage 3. Will raw meats, poultry and seafood be stored in the same refrigerators and freezer with cooked/ready-to-eat foods? Yes No If yes,how will cross-contamination be prevented? 4. Does each refrigerator/freezer have a thermometer? Yes No Number of refrigeration units: Number of freezer units: . THAWING Please indicate by checking the appropriate box how PHF (potentially hazardous food) in each category will be thawed. More than one method may apply. Thawing Process Thick Meats Thin Meats Fish Seafood Poultry Products Baked Goods Refrigeration �. Running Water less than 70°F(21°C) Cooked Frozen(indicate wt.lbs.) Microwave Other(describe): 4 COOKING PROCESS Item#1 -Will food product thermometers (0°—212° F)be used to measure final cooking/reheating temperatures of PHF (potentially hazardous food)? Yes L No Minimum cooking time and temperature of product utilizing convection and conduction heating equipment: Product Time & Temperature Product Time & Temperature Beef roast 130°F (121 min) Comminuted meats 155°F (15 sec) Seafood 145°F (15 sec) Poultry 165°F(15 sec) Port 155° F(15 sec) Other PHF 145°F (15 sec) Eggs 145°F (15 sec) * reheating PHF 165°F (15 sec) Item#2-Hot Holding How will hot PHF (potentially hazardous food)be maintained at 140°F (60°C) or above during holding for service? Indic to type and number of hot holding units. ��. i 1ai Z/`i, Item#3 -Cold Holding How will hot PHF (potentially hazardous food)be maintained at 45°F(7° C)or above during holding for service? Indicate type and number of hot holding units. Item#4- Cooling Please indicate by checking the appropriate box how PHF (potentially hazardous food)will be cooled to 45°F(7°C)within 6 hours(140°F to 70°F in 2 hours and 70° F to 45°F in 4 hours). Cooling Process Thick Meats Thin Meats Fish Seafood Poultry Products Baked Goods Shallow Pans Ice Baths Rapid Chill Other(describe): 5 FOOD PREPARATION 1. Please list categories of food prepared more than 12 hours in advance of service. 2. Will disposable gloves and/or utensils and/or food grade paper be used to minimize handling of ready-to-eat foods? Yes ✓ No 3. Is there an established polity to exclude or restrict food workers who are sic r have infected cuts and lesions? Yes No Please describe procedure: 4. How will cooking equipment,cutting boards,counter tops and other food contact surfaces which cannot be submerged in sinks or put through a dishwasher be cleaned and sanitized? Please describe procedure: // Ae ['/weal a/i i S.d 5. How will ingredients for cold ready-to-eat foods such as tuna,mayonn ise and eggs for salads and sandwiches be pre-chilled before mixed and/or assembled? J f"/►e dIL I- 6 THE FOLLOWING 4 QUESTIONS DEAL WITH FOOD PREPARATION PROCEDURES FOR FACILITIES. Food preparation procedures are needed to obtain information on how the food is prepared and to help determine that adequate facilities are available. The food preparation procedures should include types of food prepared, time of day and equipment used for service in the facility. (Attached is Food Item Preparation Worksheet Supplement for additional food items prepared in the facility.) If your company has food preparation procedures already developed,these can be submitted as part of the plan review approval process. 1. Produce Preparation Procedures a. Will produce be washed or rinsed prior to use? Yes �No b. Is there an approved location used for washing or rinsing produce? Yes No c. Will it be used for other operations? Yes No Please indicate location of produce washing equipment and describe the procedures. Include time of day and frequency for washing or rinsing the produce at this location: Please describe the produce preparation procedures and indicate location of equipment to support this operation. The preparation procedure should include dishes(proposed menu items)in which the produce will be used,and should include time of day and frequency of preparation for the produce at this location: 2. Seafood Preparation Procedures a. Will seafood be washed or rinsed prior to use? Yes No iv b. Is there an approved location used for washing or rinsing seafood? Yes No t/ c. Will it be used for other operations? Yes No kv Please indicate location of seafood washing equipment and describe the procedures. Include time of day and frequency for washing or rinsing the seafood at this location: 7 Please describe the seafood preparation procedures and indicate location of equipment to support this operation. The preparation procedure should include dishes(proposed menu items)in which the seafood will be used,and should include time of day and frequency of preparation for the seafood at this location: 3. Poultry Preparation Procedures a. Will poultry be washed or rinsed prior to use? Yes ✓ .No b. Is there an approved location used for washing or rinsing poultry? Yes ✓ No c. Will it be used for other operations? Yes i/ No Please indicate location of poultry washing equipment and describe the procedures. Include time of day and frequency for washing or rinsing the seafood at this location: Please describe the poultry preparation procedures and indicate location of equipment to support this operation. The preparation procedure should include dishes(proposed menu items)in which the poultry will be used,and should include time of day and frequency of preparation for the poultry at this location: 4. Pork and/or Red Meat Preparation Procedures a. Will pork and red meats be washed or rinsed prior to use? Yes ' No b. Is there an approved location used for washing or rinsing pork and red meats? Yes ✓ No c. Will it be used for other operations? Yes ` No Please indicate location of seafood washing equipment and describe the procedures. Include time of day and frequency for washing or rinsing the seafood at this location: Please describe the pork and red meats preparation procedures and indicate location of equipment to support this operation. The preparation procedure should include dishes(proposed menu items)in which the pork and red meats will be used, and should include time of day and frequency of preparation for the pork and red meats at this location: 8 DESIGN INFORMATION I. DRY GOODS STORAGE 1. Is appropriate dry good storage space provided for based upon menu,meals andifrequency of deliveries? Yes / No Provide information on the frequency of deliveries and the expected gross volume that is to be delivered each time. II. WATER SUPPLY 1. Please check one: Is water supply Community? Yes ✓No Municipal? Yes_ No If the Water supply is other than a Municipal supply, it will be required to be registered with Public Water Supply. 2. If water supply is from a Community Water Supply system is it registered and approv d as public water supply? Yes No If yes, please attach copy of written approval and/or permit. 3. Is ice made on premises or purchased commercially? Yes L—V No Please specify: If made on premised than specification for the ice machine will need to be provided. Describe provision for ice scoop storage: III DUMPSTER 4. Will a dumpster be used? Yes 7--No N/A Number 3. Size SUS ea,t.s Frequency of Pickup Contractor Service: 5. Will the dumpster be cleaned on site? Yes t/... No If the dumpster is to be cleaned on site, then the waster water from the cleaning operation will be required to be discharged to the sanitary sewer system. 6. Is the dumpster to be cleaned by an off site contracted cleaning service? Yes No 9 If yes,please provide name and address of the firm contracted for this service. Name: Mailing Address: City: State: Zip Code: Telephone: ( )-( - ) Fax: ( )-( - ) 7. Will a compactor be used? Yes No !/ N/A Number Size Frequency of Pickup Contractor Service: 8. Will the compactor be cleaned on site? Yes No N/A If the compactor is to be cleaned on site,then the waste water from the cleaning operation will be required to be discharged to the sanitary sewer system. 9. Is the compactor to be cleaned by an off site contracted cleaning service? Yes No If yes,please provide name and address of the firm contracted for this service. Name: Mailing Address: City: State: Zip Code: Telephone: ( )-( ) Fax: ( 10. Describe surface and location where dumpster/compactor/cans are to be stored: 11. Will trash containers be stored outside? Yes ✓ No If yes,please describe location: 40 /• 15.vt i 12. Type and location of waste cooking grease storage receptacle: 13. Is there an area to store ecyclgd containers? Yes No -B Describe: P hi,) th 14. Location and size of grease trap: 10 X. SEWAGE DISPOSAL 1. Is building connected to a municipal sewer? Yes No 2. If no, is private disposal system approved? Yes / No Pending If yes, please attach a copy of the written approval and/or permit. XI. GENERAL 1. Are insecticides/rodenticides if used stored separately from cleaning and sanitizing gents? Indicate location: Yes No 2. Are all cleaning materials and toxicants stored away from food preparation/storage areas? This includes items used on premises,retail sales and personal medications. Yes ✓No Please Describe Location: r'Qq.c 3. Are all containers of toxic/cleaning material including sanitizing spray bottles clean abeled? Yes No 4. Are laundry facilities located on premises? Yes No If yes,what will be laundered? 5. Is a laundry dryer available? Yes No ✓ If yes,please describe location: 6. Location of clean linen storage: 7. Location of dirty linen storage: STATEMENT: I hereby certify that the above information is correct, and I fully understand that any deviation from the above without prior approval from this Health Regulatory Office may nullify this approval. Signature(s) Loi01 dd'a-- &Z-Ait 1.1a. 'ia- ('-"',"- -- Owner(s) or Responsible Representative(s) Date: 0 ` — 6i 11 FOOD PREPARATION WORKSHEET SUPPLEMENT Food Item: Will the food item be washed or rinsed prior to use? If yes please indicate location of equipment and describe the washing procedures. Include time of day and frequency for washing or rinsing the product at this location: Location of equipment: Time of day and frequency: Procedure used to wash or rinse food item: Please describe the preparation procedures for the food items described above and indicate location of equipment to support this operation. 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