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HomeMy WebLinkAboutBla Yang Thao 730208 11 25 09PY.pdfTime In: 7 L m E] am Time Out: ❑pm m Total Time: ❑ B L A Y A N G T HA Name of Establishment H N C K Y F 0 R D R D H M© N C Address: N E W T 0 N City: B L A Y A N G T H' A Permittee Manager or Person in charge ❑ Mailing Address Same B L A Y A N G T H' A Mailing Name 6 6 1 6 S I M P S 0 N R D Mailing Address C H A R L 0 T T E City Phone Fax Email Address: 5-5 - Municipal/Community 3-3 Municipal/Community N/A Water Supply Wastewater System Risk Category 1 8 7 Facility ID Old Facility ID: Map # Parcel ID # Lat. Long. Push Cart or MFU ❑Pushcart ❑MFU Push Cart or MFU Name Transitional Permit Conditions: Permit Expires: Conditions/Remarks TO OPERATE 11 /26-1112 ONLY EHS Sig ture: 2031' 1 1 1 a 5 1 a 0 0 9 EHSID Date: New Transitional N' C a 8 6 5 B State: Zip: N C 2 8 2 1 6 State: Zip: l Emergency Phone Number 1 8 Catawba County # 01 Territory # Capacity: 73 m Temporary Food l Operate a: Status Code ❑Attachments 1 1 / a 5 Date ❑90 days ❑ 180 days Non -Compliant items completed by: Manager/Person in charge Title Date: ka NC Department ofEnvironmental & Natural Resources � D��onofEnv�dnnmonbHeoUh �N��T�m�no| -- -- Uohe� 11��20V9 Nome of Establishment: BL\YANGTxAO Location Address: ���x�F�����N��m�F��T City: mE«VTOm State: NC Zip: 28658 BiUingNome- BLAYANGTxAO BiUingAddnomm: 6616S|MpSONRD City: CHARLOTTE State: NC Zip: 28216 Email Addres Phone: Fox: Permission |ogranted tooperate m 73-Temporary Food Establishment Regulation of Food and Lodging Facilities. See permit requirements in Rules. oomp|ywit h mU roqu|romonto. Permittee: BLA YANGTxAO Manager/Person in Charge: County- 018 Status Code- ^ Establishment ID: Map #:------------------ Parcel |D: --------------- Lo1�_________________Lon[�____________________ Emergency Phone Number: modefined |nG.S.130A'247(|)and 130A'248. This permit is not transferable and may borevoked for failure to vvostmwotercystems� municipal/Community on'S|tecystem Copoc|ty� w vvoterSupp|y� [Emunicipo|/Community []On'Site System Pushcart/Mobile Food Unit operating in conjunction with Category�� [3] [4—] Restaurant or Commissary Name and ID numGer----------- Conmuons/nemorxs� TO OPERATE 11/26-11/29ONLY Transitional Permit Conditions This permit shall expire on and is not renewable. All non -compliant items listed herein and on attached pages (|f applicable) must uecompleted within Eloo 1oodays uovs This establishment must close if all noncompliant items are not corrected by the expiration date. Received By Manage/Person in Charge Title Date P— V__ Signed. � n�Date General o(b) establishment shall commence or continueoperation without permit or transitional permit issued by the Department revoked in accordance with G. S. 13 OA-23(d) for failure of the establishment to maintain a minimum grade of C. A p ermit or transitional p ermit may otherwise be susp ended or revoked in accordance with G. S. 13 OA-23.. " Preparation Local env ironmental health sp ecialists shall issue a permit every time a change in p ermit status is ind ic ated. Prep are an on gin al an d one copy for: 1. Orig in al to b e 1 eft with th e own er or op erator. 2. C op y for th e 1 oca 1 hea lth dep artment, D i sp ositi on : P1 ea se refer to Rec ords Retention and D i sp os iti on S chedul e 8. B. 6., for C ounty/D i strict Hea lth D ep artments wh ich is p ub li sh ed by th e North C arolin a D iv i s ion o f Arch iv es & History. uEwn1a41(revised o2/oo Environmental Health Services Section (rev|mw7/oo)