Burke County Environmental Health

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					                                    Burke County Environmental Health
                                  110 N Green Street Morganton, NC 28655
                                               828-438-5430

     TEMPORARY FOODSERVICE ESTABLISHMENT PERMIT APPLICATION


1.    Establishment Name:____________________________________________________________

2.    Operators Name:_______________________________________________________________

3.    Operators Mailing Address: ______________________________________________________

4.    Operators Telephone Number: ____________________________________________________

5.    Booth Number & Location: _______________________________________________________

6.    Date & Times of Operation: ______________________________________________________

7.    List all food items that will be prepared & sold to the public:

      _______________________________________________________________________________

      _______________________________________________________________________________

      _______________________________________________________________________________


8.    List food that will be prepared & sold at the Temporary Food Establishment (TFE)

     ________________________________________________________________________________

     ________________________________________________________________________________

     ________________________________________________________________________________


9.    List foods that will be prepared at a permitted foodservice site other than the TFE:

      _______________________________________________________________________________

      _______________________________________________________________________________

      _______________________________________________________________________________


10. List all equipment that will be used in the heating, cooling, holding, & storage of foods:

      ________________________________________________________________________________

      _______________________________________________________________________________

      _______________________________________________________________________________
11. List source of potable water: ______________________________________________________

12. List all methods of storage & disposal of generated wastewater: ___________________________

    __________________________________________________________________________________

13. List methods for storage and disposal of generated garbage: __________________________________

    __________________________________________________________________________________

14. List methods for heating water (required):________________________________________________

15. List methods for providing required hand-washing stations: __________________________________

16. List equipment to be used for washing & air-drying of food-handling utensils & food containers:

    _________________________________________________________________________________

17. List methods to be used for cleaning & sanitizing of all food-handling & contact surfaces:

    _________________________________________________________________________________


18. Will you be setting up your TFE in a tent or a mobile trailer?

    ____________________________________________________________________________

19. If setting up in a tent, describe methods for providing insect control, such as tent screens/fans,
    etc.:________________________________________________________________________

20. How will you assure that the temperature requirements for Potentially Hazardous Foods will be
    achieved and maintained during cooking, cooling, holding, and storage?

    __________________________________________________________________________________

    __________________________________________________________________________________


    STATEMENT: I hereby certify that the above information is completed and accurate. I fully understand that any deviation
    from the above information without prior written permission from the Burke County Environmental Health Office may nullify
    final approval & result in revocation of an issued permit, or result in the denial of a permit for operation.




    _______________________________________________________                                     ________________________
    Signature                                                                                   Date


    This application must be completed & returned to the Burke County Environmental Health Office no less than one week before
    the date of the event. The TFE permit fee of $75.00 must accompany this application. Cash, checks, and money orders are the
    acceptable forms of payment. No payment will be accepted by the Environmental Health Specialist in the field.




    ehs.TFE/2009

				
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