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This application must be submitted to the Richmond County Environmental Health Section at least fifteen (15) calendar days prior to the event. A $75 fee is required for each booth and must be paid with the submission of this
All food must be prepared in an approved FSE, not a home kitchen. Must include a letter from the FSE owner/operator listing what they will prepare for you, contact information, and a copy of the last inspection by the local health authority. If this FSE is out of state please call Richmond County Environmental Health Section before completing this application.
Examples include chili, nacho cheese, BBQ.
Produce includes potatoes, tomatoes, lemons, onions, etc.
Provide a complete list of a food/menu items. A produce sink will be required if produce is not purchased prewashed. Produce includes lemons, potatoes, lettuce, onions etc. Please include all add-on items such as lettuce, tomato, onion, chili, etc.
Invoices for purchases will be reviewed during permitting.
Check all that apply.
A utensil washing setup is required.
A handwashing setup is required.
Please note that a 10-by-10 tent setup is only allowed with a very limited menu.
Application(s) can be faxed to Richmond County Environmental Health Section at 910-997-8372 and payment can be called in at 910-997-8320 (leave message if voicemail). Application(s) and fee(s) can also be mailed or hand delivered to Richmond County Environmental Health, at 127 Caroline Street, Rockingham NC, 28379.
View a copy of the North Carolina Rules Governing the Protection and Sanitation of Food Establishments 15A NCAC 18A .2600 and the North Carolina Food Code Manual.
Attach or send a diagram showing the food booth set up. Drawing must show front service area, sneeze guards, handwashing station, utensil wash set up with air drying space, produce washing (if applicable), cooking equipment, refrigeration, hot/cold holding equipment, preparation areas, fan placement (if applicable), etc. Applications submitted without completed drawing will be denied.
I hereby certify that the above information is complete and accurate. I fully understand that:
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
This field is not part of the form submission.
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