HomeMy WebLinkAboutBaymont Inn & Suites 200055 12 2 15.GK.PDFTime in: 1 0 : 3 8 El am 7 PM Time 01-t:
0 a t-i 7ota Tirre: a hrsDniinutes
N pn
[kNew E] Tran sitiona I
6 a y m c n t I ]-1 11 a n d 3 U i t e 3
Name of r= sta hlishmp nt
1 1 0 1 3 t h A v e D r i v e S E
12MVIMIN
H i c k c r y 4 C 8 6 0 a
hl4yar�
Permi'tee-
Manager or Person in charge
It Mailing Address Same
Nayan Pa - ,el
M ailing Name
1 1 ;2 0 1 3 t h A v e D r i Y e 5
M ailing ddross 1
imam
H i c k c r y tt C D 8 6 0 D
a —te z —IF
Phone Fax Emergency Phore Number
Email AdId'eSS:
5-5 - MunidpalICommunifty 4-4 - On- lie System N/A
Water Supply Wastewater Systern Risk Category
0 0 5 5 Enter last 4 digits on l,,i
Facility ID Old F acility V
Man # Parcel ID ;P
1 a Catawba
'C-05 n t _Y; —
01 6 0
'Territory 9 Ca pac*#
20 - Lcdging
Op e refe a,Stailus Code
Lay, Lcn Q, Fiore,:
F—ushcart csmEu []Pushcarl []MFU
Pi,shcartfMo�4ie Food Unit operating in CorrunCtion with: Revrouraorer Commissary ID. -
Transitional Permit Conditions: Permit Expires: Non-PQ19 u days 14U DaysConOltionstRernarks vI ia nt ite rin s cc m0ete 0, 4y:
N cn-Co mpliaril R ernarys
.11
/VEI-IrSighture�'4'
1655-K,ain, Greg 1 2 1 e Z / 0 0 1 5
. . . . . . . . . . .
EHSIC Date:
M
R en a Pill g
4000
Establishment Assignad To:
fz
Ln
1655-K,ain, Greg
1 a 0 a a 0 1 5
Title Date
NG Department of Health and Human Services [j]Per-nit F-]TransitionalPermit
Division of Public I I ealth
Envircinmentat Ficalth Soction Date: 12102�2015
N @me of Establishment: Bay" ont Inn and Suites P erm ittee: Mayan Patel
City: Hickory
State - ING Zip: 28602 rvIanagcr/Pcr-,o,n in Chargic-,
BEllng Name Noyon Potol' County Catawba
BfilngAddress_ 112U 13th Ave Drive SE,
City, Hickory State:,NC Zip,: 28602 Status Code: I
Email Address: —Establishment ID:- 2018200055 - - - - - - - - - - - - - - - - - - -
Phone- — Fax: map, #:-----.--.--------Marcel ID -- - - - - - - - - - - - -
Emergency Phone Number Let` . . . . . . . . . . . . . . . . Lo n ce . . . . . . . . . . . . . . . .
Permission is granted to operate a, 20 - Lodging asdefined inGS 130A-,247(l) and 1 MA-248,
Regulation of Food and Lodging FactIrtes. See permit requirements in Rules. This permit is not, transTeraNe and may be revoked for failure to
c a mply w th all requirements
WastexeaterSysterns: Elmuricovcmmunk, n-site System Capacty: 60 category 91 E ff]
WaterSupply: HIM uricouc)mmunity E]On,-Sits Systern 11 IE
Fushc3rt'Noblle Food Unitope,ating in conitinvion with 8 e sTau rent or COMM SSay Name alto-0-1M56-eT — — — — — — — — — —
Cc no it! on &Rem a 0&
Ecta,bllshrrentassigned to: 1666Kbin,Grag
Transitional Permit Ciandition$
-hia; permit smell expire 01 and is not renewable, All nan-comrlian' items listed herein and on attached Gages (if
anali--ablp,) must he cDnmc.leteJwilhln 9 0 /E] 180 daYs days. This astablishment mist close if all noncornaliant i,.ems are not corrected be the
expiration da:e.
RP'rP.lvPd aye 'A,- Tito nmw 12-02r,015
M 3nageriPerOn inn -Charge
Signed BY: '4 ') RE HS#: 1Kajn, Greq Date: 12192f2015
or, t P dlic ealth
laurpwe; General Statute 13&k '25,>S(b�,� states "-No eotablishna--et shall --cmmenw of mntnueoperasion withour a lammit ortmnsitionrl permit ismed bythe Deep artty&,nt-
'Me pttrnit or transitional peimit lall he issued to the, olvm-r or operator of the establistment and Mall not be nnffetablt- Ythtestablislinent is lased, the rml of
transitonal ptmt diall be issued to the lessee and shall not be transftrablt,. If Ilic location of an establishment changes, a rreNvipffmit strap be obtained for the
establislarritrit- A p=it shall be issued only vlien the tstablishm-ni mfisfes all of the, requiternents, cf the rules- Tlit. Comrnis,4on shall a&pt rules est2blislung the
requirements dut must be met before a transitional p=t mays be, issued. and the penat for wtudi a transticaral pffiratmay he issued. T'he Dtpartrnent rnav also impose,
ucqlditun' UTI thr risuatice Ufa ptalint of tiallsidunal ImIlIft in iuIt.s,&d-jpLtd by flit, CuTilunssmi- A ptirift Ln Uansitiunal pnTuit Malt bc il-iniodiaLdy
t�e�okt,d in aceordanet, nsitft l?IaP.-i�(d"t fir€ failure of tine estabfi= stir to rriaintair a rznlrniarutn grade of C tnt,riniit �arsitic�nal .t may„ otiln b"e
suTerdtdo,rzecvokt.din,accc,rdarce,k7kithG-S- 13DA-23--" Preparation : Localm)cironmental health speciAists shall issue,apennitevery - brine Changein it status is
indica-,ed. Prepare an ongind and one cop77 for I.Onggua2l 2. Cop-y far &.elocal Disease reki-to
Records Retmtai and Disposi dcn Schedule 8 B .6., far -Count,17,Iti stnct Health Departments NIii:li is pubd gied by the North Carolina EX;a sion ofArchives & History
Additional faints rnav be ordmed from: Fnvironinnentai Healtin St:fior, 1,632Mail Service Center, Raleigin, -INK 27699-1632, (Courier 52-01-0a)
EH3 1341 (revised 07112)
E,rvironmenta,l Health Section
Comment Addendum - Attachment
EstaWln�jirr�evt VaTj�e: Raymonf Inn and Sultes
Location Address,: 112013[hAire UnveSE
City: Nckwy
County, C3tawba
Wastewater System: o klunicipavCornnuniV @ on-Sita System
Water Supply: @ NIL 7 lta C, SIYSSM
Permiltee: N"byan Pate
was=
Condlllons/RemarKs ilcontlnue,3):
Mon---orrpliait Items:
Data- iz�ozi2o16
Status Code: I
Gategory4., 0