HomeMy WebLinkAboutBerliner Kindl 730177 10 9 09GK.pdfTime in-
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Name of
Establishment
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Address-
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City:
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T r u b e
Permittee
Manager or Person in charge
F] Mailing Address Same
S h a r o n T r u b e
Mailing Name
1 a 1 B r o a d w a y S t
MailingAddress
B I a c k M o u n t a i n
City:
Phone Fax
Email Address-
5-5 - Municipal/Community 3-3 - Municipal/Community N/A
Water Supply Wastewater System Risk Category
a 0 1 8 7 3 0 1 7 7
Facility ID [—] Existing Facility? Old Facility ID -
Map #
Parcel I D #
Lat- Lang_
PushCart or MFU [—]Pushcart [—] MFU
Push Cart or MFU Name
Transitional Permit Conditions: Permit Expires-
Con ditIon s/R e marks
Establishment Assigned To-
1655
EHS Signature-
1655 1 0 / 0 9 / a 0 0 9
EHSID Date-
N C d 8 6 0 a
State- zip-
N C 2 8 7 1 1
State- zip-
Emergency Phone Number
1 8 Catawba
County #
01
Territory # Capacity-
73 - Temporary Food I
Operate a- Status Code
FlAttachments
1 0 / I a / a 0 0 9
Date
E]90 days E] 180 days
NonCompliantitems completed by_
Manager/Person in charge
1 0 / 0 9 a0 0 9
Title Date--
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NC Department of Environmental & Natural Resources
Division of Environmental Health
[#]New [—]Transitional
man=
Name of Establishment: BerlinerKindl
Location Address: Cktoberfest
City: Hickory
Billing Name Sharon Trube
BillingAddress: 121Broadway St
City: Black Mountain
Email Address:
Phone:
Perm ittee: Sharon Trube
Manager/Person in Charge:
State: NC Zip: 28602 County: 18
Status Code.
Establishment ID: 2018730177
---------------------------------
State: NC Zip: 28711 Map #: ------------------ Parcel Ili_--------------
Lat: ------------------- Long: ---------------------
Fax: Emergency Phone Number:
Permission is granted to operate a 73 - Temporary Food Establishment as defined in G.S. 130A-247(l) and 130A-248,
Regulation of Food and Lodging Facilities. See permit requirements in Rules. This permit is not transferable and may be revoked for fallure to
comply with all requirements.
Wastewater Systems: [EmunicipaliCommunity [—]On-&te System Capacity: Category #: W I F21
Water Supply: [Emunicipai/Community F-]On-site system 0 P]
Pushcart/Mobile Food Unit operating in conjunction with:
or Commissary Name and mn-------------
number
Con diti on s/Re marks-
F]Attachments
Transitional Permit Conditions
This permit shall expire on and Is not renewable- All non compliant tems listed herein and on attached pages (if
applicable) must be completed within F-1 90 / F-1 180 days clays- This establishment must close If all noncompliant Items are not corrected by the
expiration date -
Received By- ManagelPerson in Charge Title- Date- 10109/2009
Signed:— —)4 f tw RS#- 1655 Date- 10/09/2009
Division of Environmental Health
Purpose: General Statute 13OA-248(b) states "No establishment shall commencecT continue operation without a permit or transitional permit issued by the Department -
Thep emiit or transitional permit shall be issued to the owner or operator of the establishment and shall not be transferable- Ifthe establishment is leased, the permit or
transitional permit shall be issued to the lessee and shall not be transferable- Ifthelocation of establishment changes, a new permit shall be, obtained for the
establishment - A Permit shall be issued only when the establishment satisfies all oftherequirements, oftherules- The Commission shall adopt rules establishing the
requirements that must be met before a transitional permit maybe issued, and the period for which a transitional permit may be issued- The Departmentmay also impose
ccuditions, on the issuance ofa pa-mit or transitional permit in accoTdanceivith rules adopted by the Commission- A permit or transitional permit shall be immediately
revoked in accordance with G-S- 13OA-23(d) for failure ofthe establishment to maintain a minimum grade of C- A permit or transitional permit may otherwise be
suspended or revoked in accordance with G-S- 130A-232 Preparation- Local environmental health specialists shall issue a permit every time a change in permit status is
indicated- Prepare an original and one copy for: 1- Original to be left with the owner or operator- 2- Copy for the local health department Disposition: Please refer to
Records Retention and Disposition Schedule 8-B-6-, for County.,"Di strict Health Depaitments,�vhich is published by the North Carolina Division ofArchives&-Histm-
Additional forms may be ordered from- Division ofEnvironmental Health, 1632 Mail SaviceC enter, Raleigh. NC 27699-1632, (Courier 52-01-oft)
DENR 1341 (revised 02/08)
Environmental Health Services Section (review 7/08)