HomeMy WebLinkAboutBerlinder Kindl 730975 10 07 16.LS.PDFTime In, 0 9 : 3 a am Time Out: 9 : 3 3 F5 am TulalTirne, 3milnute3
PMWNew ETransitional
B E R L I N E R K I N D L
Name ol`Establ�shment
1 12 1 B K 0 A D W A Y 5 1
Address 1
B L A C K M 0 U N T A I N
B E R L I N E R K I N D L.
Permiltee
M anager of Person in charge
E] ki ailing Address Same
.......... I ..........
1A ailing Name
N C a 8 7 1 1
3tate-. zlp:
IA ailing Address I
hl ailing Address 2
N C
Qgig staW zlp�
Phone Fax Emergency Phone Number
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Email kddress-1
5-5 - Municipal,Community
Water Supply
0 9 7 5 440 Enter lasl 4 digits only
Facility m
3-3 - Municipal/Community N/A
Yvastawalef Systern Risk Category
Old F acioty iL)
M ap # Parcel ID #
. ....... . ... ..........
t-at Long,
Push Cart or MIFU E]Pushcart EIMFU
Push carWA a bile Food Unit operatinq in conjunction with:
Transitional Permit Conditions: Permit Expiifvs;
conanionstRemarKs ---- --- -
TWRLl 10916 ONLY O�CTOBEVFEST
f4cmCompliant Remarks
1 8
County
C1
Territory 4 Capacity-
73 - Temporary I
qi=.At
operate a: 5fams code
1 0 0 7 1 � 0 1 6
.. ... ........
Date"
Restaurant or Commissary IV:
Estat4shment Assigned To
1896-Sears, Luke
/F"- �..��_Stgnaturel
1711 -Carpenter, Scott 1 0 / 0 7 / a 0 1 6—
EHSID Date: 017_777_111111111111111.'
0 days [] 180 days ul�
Non- ,"pliant ite rns co rn plete d by:
1:1 clxk sh! chtckboIx fi0 0d r,^maAs
M anager/Person in charge
1 0 / 0 7
Tile Date:
Ram..e
3971
NG Department of Health and Human Servlces [j]Perrnit TransitionalPermit
D iv ision of Public I I ealth
Environmental Hoalth Soction Date: 1010T2015
Name of Establishment: BERLINER KINDL P erml ittee: BERLINER K[NDL
WFAIMMI
City: BILACKMOUNTAIIN
State - NC Zip: 28711 rJanagiar/Piorson in Chargc-,
l3thrig Name- County Catawba
Willing Address_
C ity, State:,rp: —Status code:
E m a 0 Add irt ss Establishment ID, 2018730975
Ph ne- Fax: Map #� - - - - - - - - - - - - - - - . Parcel ID- - - - - - - - - - - - -
Emergency Phone Number. Lat ................ . LanT ................
Permission is granted to operate a 73 - rernporary Food Establishment asdefined inGS 13OA-247(l) and 1 MA-248,
Regulation of Food and Lodging Facilities, See permit requirements in Rules. This permit is not, transferwie, and may be, revoked for failuria to
comply wth all requi-ements,
WastexeaterSystern s: Riviuricouc:immunk, []on -site System Capacty�
categorf #: 91 E ff]
WaterSuloply: [EMuricipaliCammunity E]On-Sits ystern 11 IE
Fushc3rt'Noblle Food Unit ope-afing in conjun0on with Restaurant Or COMM SSa'NV Name any-3—iUn3EJ — — — — — — — — — —
CcriditionvRemark&
Ectablishrrent assigned to: 1806-Goaro, Luko
T,AnU 10,016 ONLY OKTOBEnFEST
- ----- - ---------- ---
$i tion a I Penrn it Condition%
-hi$ permit $1hall expire 01 and is not renewa4le, All inan-comrlian' items listed herein and on attached cages (if
anali-mblp,) must he cDrnic.IeteJwilhIn 90 /E] 180 daYs days. This astablishment mist close if all noncornaliant '.ems are not corrected ine the
expiration da:e.
Rp'reNpri Py Tit Pr
M 3nageriPerson in Charge
n,t,, 10AM2016
Sioned By. ,0 PEHS#: 1711-Garrienter, Date: 1007,Q016
P u b I i c H e a, It h
Purpwe; Generr'if Statute 1 3ak 2'S (W "tat s "N70 f-,.tab1BbMmt --hall --ommenLe of continue operation v%ithout a pennit of tmnai*r otizl permit i smed, by the Lip artinwrit-
'Me ptrmit or transi tonal penrlit 42211 he issued to the, ox-ner or Operator of he establishment and shall not be 'Lm n sfemble- Y the establi shment is lased, the permi t or
transit oral pemi t shall be issued to the lest and shall n at be tnns ffrable.. If it e locator of an e st abli shment changes, a neNv pt= t shall be cbtai ned for the
e sta bl ishrritnt - A pe =it shall be, issued only xvlren the e stab.t i sl it nunt sati 9 f e s all , of the requirements cf the rules - The C ornrifi m m shall adopt nu ea e st, Ebl i sfii ng the
requirements tha t mu st be met be -ore a transitional perm t may be issued; and the period for wht ch a trans-.tional ptfmit may be i s sued, Tice Dtparnnexit nia v also i nipose,
cundi t um, un Liar i saj�ricz of a Im un t ui tratin d unal purin t m a cuui darxr. Nvi it. subs ad.,Lipttd 1ay ffir C urium ssi un - A pm tin t Ln it a ri 24 Injual pin i ii L Aral I be itanit4i aLd V
revoked inaccordarce. ivith G_S_ 130.4-23(d) for fitilureof the establii5hnaem to inaintair a nimitrum gradt. of C_ A permit or trarsifictial permit may oidtiervise, be
suTerdtd or rcvokt.d inacccrdarce with G_S_ 130.4-23" Preparation : Local enNinnamental health specialists, shall issue permit even- time .9 change, in pe =it status is
indicated. Prepare an onginal and one copy for I . On pn2l to be left vath ihezwmer or operator, 2 . Cop-y for the local health departrnant. a spasinen: Please refer to
RecoAs Retentai and Disposition Scttdule 8B 6, for �.-ountyiDiislrrict H.-,alth Depa=mts,,N1uzh is pub;Agied bythe North Cxolina avision of Archives & History
Additional forms may be ordered from: Fmirommmitai KealtA Sector, 1632 Mail ice Center, RaJeigk -.xC 27699-16,32, Q:�,oariez 52-01 -oal
EH3 1341 (reviseO 07912)
Ery iron m enta] Health Section
Comment Addendum - Attachment
EstaWln�jTtevt VaTte: REM INFR KINDII,
Location Address: 121BROADWAYSI
City: BLA10,KMOUNTAIN
County, Catawba Zip, 28711
Wastewater System: (j) klunicipavCornmuniV C) On -Site System
Water Supply: @ C, 'fin-sitE sysksm
Permiltee: BERLINER KIN
gum=
Condlllons/RemarKs ilcontlnue,3):
Mon---orrpliait Items:
Date- 1W07,2016
Status Code:
at go ry 4.,