HomeMy WebLinkAboutBerliner Kindl PERMIT 730896 10 09 15.LS.PDFTime im 0 9 : 4 1
B E R L I N E R
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4 5 [Earn Total Time: 4 minutes
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R M A N R E S T A U R A N T
RNew F�Transifional
Name of Establishment
I a 1 B R 0 0
D W A
Y
Address 1
address.
B L A C K M 0
U N T
A I N
N C a 8 7 1 1
City:
State: zlp.
B E R L I N E R K I N D L
Permittee
M anager or Person in charge
E] 10 ailing Address Same,
B E R L I N E R K I N D L
14 ailing Name
I 1� I B R 0 0 D W A Y
1A ailing A ddre as 1
1A ailing Address 2
B L A C K M 0 U N T A I N N C .1 8 7 1 1
City; pp State: ZIP:
Phone Fax Emergency Phone Nurricer
1 8 C atawba
Email Address: CoMy #
5-5 - Municipat/Community, 3-3 - Muni cipallCommunity N/A 01
Water Supply Wastewater System Risk Category Territory # Capadty°
0 8 9 6 *Enter Iasi 4died sonly 73 - Temporary Food I
esokliq4r#"AF4
Facility ID Cold Facility ID: Operate a: Status Code
14 ap # Parce]AD #
1 0 1 0 9 0 1 5
Let Long, Date:
Push Cart or K4FU [:]Pushcart E]MFU
Pushcarliklobile Food Unit operating in conjunction with:Restaurant or Commissary ID.,
Transitional Permit Conditions: Permit Expires: '0 days 180 days
Condition sIR am arks Non "'pliant items completed by;
FOR OKTOBERFEST ONLY. EXPIRES 10.11.15
3962
Non -Compliant Remarks El C)rk the checkbox to add non-comptaor remarks
Estattishment Assigned T ci.
1896-Sears, Luke
HS Signature: M anageriPerson in Charge
1896-Sears, Luke 1 0 / 0 9 / 2 0 1 5 1 0 / 0 9 0 1 5
EHSID Date: Title Date:
NG Deparlment of He a Rh and Human Services [j]Permit F-]TransitionalPermit
D iv ision of Public I I ealth
Environmontat Floalth Section Date: 10109i2015
N @me of Establishment: BERLINER KIINDL GE MAN RESTAURANT Perm ittee: BERLINER KIINDL
lzrmzw MARM23M
Gly: BLACKMOUNTAIN
State - NC ZID: 28711 Managcr/Pcr-,o,n In Chargo:
Btflng Name BESILINEIR KINDL County Gat"ba
Billing Addres121 BROODWAY
City, BLACKMOUNTAIN State:,NC ip281111 status Code: I , —
E m a 0 Add rt ss: Estrabhshment ID, 2018,730896
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Phone- — Fax" map, #: - - - - - - - - - - - - - - . Marcel ID- - - - - - - - - - - - -
Emergency Phone Number Lot' -----..----.-.--.-- . LonT ................
Permission is granted to operate a 73 -Ternporary Food Establishment as defined in G.S. 130A-247(l) and 1 MA-248,
Regulation of Foid and Lodging FaCillties. See permit requirements in Rules. 'this permit is not, transferaNe and may be revoked for farlur-a to
comply wth all requirements.
WastexeaterSystern s; Rmuricovc�rnmunk, [:]Cn-Site System Capacty:
categorf #: 91 E ff]
Water Supply: [E]m uricipalIC)mmunity E]On-Site ystern El
Fushcairt'Nobile Food Unitope'ating in conjun0on with ReSTaurStit Or COMM SSa'y N3Me anti 0 IM56J — — — — — — — — — —
CcnditionadRernark&
E etablishrre nt 3 ssig nod 'to: 1806-Scara, Luke
FOR 0KTOBERFESTONLY. EXPIRES 10.11,15
............................................................... .... .....
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$itionall Perrn it Condition%
-his permit shall expire 01 and isnotrenewahle. All n,,in-comrlian'. items listed herein and on attached Dages (if
must he cDrniaIeteJwiIhln _:1 90 /El 180 days days. This Pstablishment rinist close if all noncompliant j,.ems are not corrected had the
expiration da:e.
RP,rP.lvPd rya' Tit p,
M 3nageriPerson in Charge
n;;tp, 1010912015
Signed BY: REHS#: 189&Sears.Luke Date: 100912015
of Pu clic Health
Purpwe,G&deral Statute 13021s 218(bstata"N'o ectablBbmentNall --ornmence or continut-opefahon vathout a permit of txansitionzI permit ismied lthe Eteoar, tment
'Me ptmitor transitional permit sFiall Lae iisuied lea flit, iyxvneror ol)erarar ofthe catablistmEnt and shall nett betransfer able_ Y the establishment is, lased, the pet tritor
transitonalptmt shall be issued to the lessee and liall not be tnins,ftrabIt. If Ine locatian of an establishment diaAges, a rigs pffmt shall be, obtained for the,
establishrrittit A it shad be issued only v,'herr fine establislatomt safisfies all of the requinernents,cfthe niles- 'Me, Corntrission shall adopt rules est2blisliing the
requirements dut must bernet leefore a transitional pertrit mix, be issued, and the pen far wtucha =s-.tional pertnitmay be issued. TlwDtpartnev, znay also irnpose
culditum'U'll fliriumictf Ufa prrmt ui tiariadun;A ly floe Cumniissiun- A Ptlyint Lyi narikkonal pciTint Ball be irinitdrattty
t-e�cke,din,acr-orda,ncei�ithG-S- 130A -23 (d) for failureof ffie e-slabli sbment to truaintair a rninitrurn gnde of C_ A perruit or tar siticnal pennit rnaN, otilemi se be
indicated. Prepare an onginal and one cop77 for 1.0nonal to be Left ,vith ffiezvmef or openaor. 2> Cop-y for tie local healtadepartm,-rit. Ihspmtion: Please refer to
RtzoAs Retmton and Disposition Sdiedule 8B.6., forCountyDi strict Haalth Depa=xm.ts v1n:h is pub.i slied by the North Carolina EX°,i sim ofArclaives & histor%P
Id32X1afl
EH3 1341 (revisecO712)
Ery iron m enta] Health Section
Comment Addendum - Attachment
Location Address: 121 BROODWAY
City: BLACKMOUNTAIN
County, C-3tavyba Z ip: 28711
Wastewater System: (j) klunicipavCornnuniV C) On-Sita System
Water Supply: @ ""n-sits sysksm
Permiltee: BERLINERKINDL
gum=
Condlllons/RemarKs ilcontlnue,3):
No n---orrpliait Items;
Date- iotoe�2oi6
Status Code:
Cate gory 4.,