Temporary Event Coordinator Application

(SUBMIT 30 DAYS PRIOR TO EVENT)

This application must be completed and submitted to Cleveland County Environmental Health to provide information about ALL food preparation and/or sales to the public at any public event or exhibition within Cleveland County by the organizer. Each food vendor/booth MUST complete a separate Temporary Food Establishment (TFE) Application which must be received by the Cleveland County Health Department with a payment of $75 no less than 15 days prior to the event. Some food vendors may be exempt, and payment may not be required, but ALL food vendors MUST complete a TFE application form.

Event Name:
Event Location Address:
Event Date(s) and Time(s):
Rain or shine event? yes, no, or alternative date:
Event Sponsor:
Name of Event Coordinator(s) and contact information prior and during the event:
Name:	Email:
Daytime Phone #:	Cell Phone #:
Name:	Email:
Daytime Phone #:	Cell Phone #:

Check the following for the water source for food vendors:
Public Water Taps accessible for all food vendors	On-Site Private Water Supply
Public Water for food vendors by fill-up only	Food vendors must provide their own water
Check the following items supplied for the food vendors by the Event Sponsor:
Electricity	Refrigeration	Toilet Facilities	Drinking Water Taps
Recycling	Garbage Pick-Up	Grease Disposal	Wastewater disposal

Will the event include a petting zoo or animal rides? Yes No

If so, are you providing hand washing station(s)? Yes No

Will the event include spas/hot tubs operating for display? Yes No

Complete a list of all food vendors that will be participating using the chart on Page 3 of this application.

Please provide a drawing of the layout of the event area including vendor locations, water connections, toilet facilities, wastewater disposal sites, garbage disposal sites, hand wash facilities, and parking. If you already have

a sketch on other paper, please submit a copy.

Temporary Food Establishment (TFE) applications and other information are available on the Cleveland County Health Department website. All TFE applications and fees must be submitted to the Cleveland County Permits Office at 1333 Fallston Road in Shelby no less than 15 DAYS prior to the event. If you have questions, please

call the office at 980-484-5130.

Event Coordinator Signature	Date Application Submitted

Applications can be submitted in person or by mail to:

Cleveland County Permits Office

1333 Fallston Road

Shelby, NC 28150

*** Please call 980-484-4779 to arrange for submission of this application***

Rev. 12/23

Name of Food Vendor/Booth	Owner/Operator	Mailing Address	Phone #/Email	Claiming Nonprofit Corporation Exemption (Yes or No)	Operating under only *NCDA regulated foods (Yes or No)	Operating as a NC permitted **MFU or Pushcart (Yes or No)	Menu Items
EXAMPLE John Doe’s Eats	John Doe	Street address City, State, Zip	485-555-0000 jd@gmail.com	No	No	No	Hotdogs, fries, sandwiches

Note: Exemption claims including a nonprofit corporation exemption, operating under only NCDA regulated foods or operating as a NC permitted MFU or Pushcart are subject to review by this department. NC permitted MFU’s & Pushcarts are required to report to their permitted commissary daily.

**MFU-Mobile Food Unit *NCDA-North Carolina Department of Agriculture