HomeMy WebLinkAboutBlanca Oshaya Permit 0730885 08 09 15.PL.pdfTime In: 9 : 5 0 0 am; Time O1 W1 ot ut: 1 0 : 5 a rn Tal Time: 25 minutes
El PM — El pirt +01�ew �Transifional
B L A N C A 0 S H A Y A
Name of Establishment
Y 0 5 0 Y G R 0
U P E R
0 A T H I C K 0 R Y F A I
R G R 0 U N D S
Address 1:
ress
N E W T 0 N
N C D 8
6 5 8
City:
state:
zlp.
B L A N C A 0 S H
A Y A
Permittee
M anager or Person in charge
[:] M ailing Address Same
B L A N C A 0 5 H
A Y A
14 ailing Name
1 8 .1 5 9 T H A
V E N
E
1A ailing Address I
M ailing Address 2
H I C K 0 R Y
N C .1 8
6 0 a
City:
pp State:
ZIP:
Phone
Fax
Emergency Phone Number
1 8 C atawba
Email Address:
County #
5-5 - Municipat/Community
3-3 - Municipat/Community N/A
01
Water Supply
Wastewater System Risk Category
Territory #
capacity:
0 8 8 5 *Enterlast4dlgatsonly
73 - Temporary Food
esokliq4�#"AF4
I
Facility ID
0 W Facility ID:
Operate a:
Status Code
M ap # Parcef M #
0 8 1 0 9 a 0 1 5
Lat. Long. Date:
Push Cart orMFU [:]Pushcart E] M FU
Pushcarliklobile Food Unit operating in conjunction with:Restaurant or CommissarylD.,
Transitional Permit Conditions: PermitExpires: 0 days 180 days
ConditionsIR am arks Non-po"pliant items completed by;
4000
Non -Compliant Remarks Click the checkbox to add non-comptaor tmarks
Estattishment Assigned To.
2031-Levin, Paige
k "�-EHS Sigiature: M anageriPerson in Charge
2031-Levin, Paige 0 8 / 0 9 1 2 0 1 5 0 8 / 0 9 0 1 5
EHSO Date: Title Date:
NG Department of Health and Human Servlces, [j]Permit F-]TransitionalPermit
D iv ision of Public I I ealth
Environmental Hoalth Soction Date: 08109i2015
Name of Establishment: BLANCA 0SHAYA P erm ittee: BLANCA OSHA YA
VIEW =41
Cly:NEWTOft
Statc , Nr_ Zip: 28658 rvianagcr/Pcr-,o,n in Chargc-,
Milling Name- BLANCAO'SHAYA Grunty Catawba
BfilngAddre18259THEVE NE;
City, HICKORY State:,NC Z rp: 28602 Status Code: I
Ernail Address: Establishment ID, 2018730885
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Phone- - Fax: Bata P #:-----.----------Marcel ID -- - - - - - - - - - - - -
Emergency Phone Number Lat ................ . Lon ................
Permission is granted to operate a 73 -Temporary Food Establishment as defined in G S. 130A-,24?(1) and 1 MA-248,
Regulation of FoM and Lodging Facilities, See permit requirements in Rules. This permit is not, transferaNe 3nd may be revoked for failure to
comply wth all requi-ements,
WastexeaterSysterns; Rkiurrcfpevc�mmunk, [:]On-Sfe, System Capacty�
category #: 91 E El
Water Supply: [flM uricipalIC)mmunity E]On-Site ystern 11 IE
Fushc3rt'Nobile Food Unitope'ating in conir,invion with Restaurant Or COMM SSa'y Name an -3-iUrri6-eT - - - - - - - - - -
Cvnditlon&Remark&
E etablishrre nt assig no d 'to: 2031-Lovin, Paige
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iii;itionall Perrn it Condition%
-his permit $hall expire 01 and is not renewahle. All ri,,in-comrlian° items IWed herein and on allacheO, Danes (if
appiisahiat must ne cDrnic.leteJwilhln 90 /E] 180 daYs days. This establishment mist close if all noncornaliant imms are not corrected had the
expiration da:e.
Rp,roNpri rya' Tito
M 3nageriPerson in Charge
n;;tpr OM912015
A
Signed BY: REHs#: 2031-Levin7 Paige Date: 080912015
DiOon of Pittlic ' Health
�o e!t -ommmw or continue ope-fatics vathcut a permit of transnonzi permit ismed by the D��Parnnent_ Purpw�e; Gene-ral S te130,N _8(b%stans"N tobli7hmmt stiall L
'Me it or trap tonal pe-ffnit 3ial4 he issued to flit oxmer or operator of the establistment and shall not be transfer -able- If theestablislunent is leased, the, ptrmif or
transitonal pemt Ball be issued to the lessee, and shall not be, transferablt,. lf he location of an estatliFlianent chakges,a ntwp emi: strap be obtained for the,
establishnitiat- A portent ;hall be, isaied onI7; vttn ffie, establishramit sati s fesall of ke rquirernentsof the rules - The Comm shorn shill adopt rules estzb1i shing the,
requirements drat must be, met before a transitional pemt max, be issued, and the period for whch a rrans,.tional pemtmav be issued, The Dtparhnent may also impose
coldi tum, un ffir i �Suiulot Uf a Im 111i t Ul trank duTral Palm t inacuuidanLr, -,Ni LL i ults,adoptrd true der CuTnun ssiun - A parrot ul uang t1unal prilln t hall be irmilrdiawt v
revoked ire accordance 1xith G_S_ t 30A-23(d) for failure -af the establishment to maintaira irfinitrurrigrade of C_ A p =.vor trar-siticnal permit may, othtt-vviw, be
susiperd,ed or zcvokt.d ire ace with G_S_ 130.4-23" preparation - Lozal enNitumnental health specialists shall issue a permit evtn: time .9 Change in pennit status is
irAi ca-,ed. Prepare an oripat and one cop77 for 1. Onorral to be Left vath theoiNmer or openiton 2. Copy, for d.e local health department. Di spasitican, Please refer to
Reconis Retmtai and Des —ition Schedule 8B .6, for CountvDistrict Hialth Depa=.errtsx%1u:h is pub.'ished bytht. -North Ciolina avision ofArchnts & Historv:
Additional forms may be orciffed front: EmIrostnetatal Heafta Sectior., I d.12 Mail Senice Center, RaleizA NK 276199-1,632, (Courier 52-01 -0:? r
EH3 1341 (reviseO 07912)
Ery iron m enta] Health Section
Comment Addendum - Attachment
Establishment Narre: 4I-ANrA,Q';HX(A
-ocationAddrelss, YO SOY GROUPERO AT HICKORY
- NEWTMA
C, ou n
Wastewater System: (j) klunicipavCornmuniV C) On -Site System
Water Supply: @ C, on- sitL� Sysksm
Permiltee: BLANCAOSHAYA
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Condlllons/RemarKs ilcontlnue,3):
Mon---orrpliait Items:
Date- 0810C,/2016
Status Code:
Cate gory 4.,