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The intent of this application is to provide information in addition to the plans regarding the operational procedures of the facility.
The Governing the Sanitation of Food Service Establishments (15A NCAC 18A .2600) require that plans be submitted for approval prior to construction. Plans must be submitted with the necessary paperwork (see following checklist) to the Richmond County Health Department.
The following items must be submitted with this application:
Upload Establishment Plans, Commissary Form, and Menu
(Corporation if Applicable)
(Commissary must be within Richmond County.)
Please note that Commissary Form must be completed and submitted to the Richmond County Health Department prior to issuance of permit.
Must be smooth, nonabsorbent, and easily cleanable.
(Please specify if outlet is on inside or outside of truck and where wastewater will be drained.)
(This in addition to lids on containers; umbrellas and canopies are not sufficient.)
All produce must either be washed at the Commissary or be purchased prewashed. Be sure to specify where (at Commissary or on unit) that the food will be thawed, cut/wash, assembled, cooked, cold/hot held, and reheated. Please use one group of fields for each food item, and include all beverages.
All equipment with the exception of microwaves, mixers, toasters, hot water
heaters, and hoods must be NSF/ANSI approved. Equipment must also be used for its intended purpose. Please list the equipment.
Completion of this application indicates that the applicant understands and intends to comply with the provisions of all related sanitation laws, rules, and regulations pursuant to 15A NCAC 18A .2600 of the Rules Governing the Sanitation of Food Protection of Food Establishments and the NC Food Code Manual. Construction shall not begin until plans have been approved. It is understood that:
I hereby certify that the information in this application is correct, and I understand that any deviation without prior approval from this Health Regulatory Office may nullify plan approval.
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.
Rule 15A NCAC 18A .2670(d) in the Rules Governing Food Protection and Sanitation of Food Establishments imparts that: "Pushcarts or Mobile Food Units shall operate in conjunction with a permitted restaurant/ commissary and
shall report at least daily for supplies, cleaning, and servicing."
If wastewater is disposed into on-site system and/or if facility is on a well, septic system and/or well must be evaluated, and approval must be granted from Health Department.
As the permittee or operator of the food establishment listed, it is my intention to allow my facility to serve as a commissary for the Mobil Food Unit or Push Cart listed. I understand that the Mobile Food Unit or Push Cart must return to my facility on a daily basis for servicing of the following requirements:
I understand that this agreement shall remain in effect until I notify the Health Department and the Mobile Food Unit's or Pushcart's owner in writing to rescind it or until the owner of this operation changes.
This field is not part of the form submission.
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