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HomeMy WebLinkAboutPanera Bread 011448 TRANSITIONAL PERMIT 05 23 17Time In: 9 4 - 0 . ❑ am Time Dirt: 4 : 4 5 0 am Tota[ Time: 45 minutes ❑ PM P P A N E R A B R E A D ❑New [i]Transitional Name ofEstablrshment 9 7 0 a N D 5 1 N E Address 1: Address 2: H I C K O R Y N C 1 8 6 0 1 oily: State: ZIP: C 0 V E L L I E N T E R P R I S E S Permittee K A T H Y P A R K E R M anager or Person in charge 0 Mailing Address Same C 0 V E L L I E N T E R P R I 5 E 5 Mailing Name 9 7 0 2 N D S T N E Mailing Address 1 Mailing Address 2 H I C K O R Y city: rr l Phone Fax N C a 8 5 0 1 State: ZIP: Emergency Phone Number 1 s Catawba Email Address: County # 5-5 - MunicipalfCommunity 3-3 - Municipal/Community IV 01 9 0 Water Supply Waslewafer System RisK Category Territory # Capacity. 1 4 4 8 Enter last 4 digits only x 0 1 8 0 1 1 0 6 1 1- Restaurant T Facility ID Old Factlity ID Operate a: 5raws CoAe M ap Parcel ID # 0 5 f a 3 1 a 0 1 7 Lat. Long. Date: Push Cart orMFU ❑Pushcart F1M FU PtlshcartlMobile Food Unit Operating in Conjunction with; Res[auran t or Co mmissary !D: Transitional Perm it Conditions: Permit Expires: 1 1 1 1 9 ! a e 1 7❑90 days © 180 days ConaltrOnslRemarts Non-Compliantitems compietedby: Nan -Compliant Remarks c W41:aers sv"a Pl bo 3999 CJkk the cneckbox to add non-oo mp ianr rD mar rks. 0 Am rre at rs Rfifl 7ADA0 4000 Establishment Assigned To: 1896 -Sears, Luke C96 -sear.. Lu Signature. M anager►Person in charge C96 -sear.. Lu a 0 5 1 a 3/ a 0 1 7 0 5 1 a 3 1 a 0 1 7 E1101D Date. Title Dare: Print NG Department of HeaIn and Human Services Division of Public IIealth Environmental Health Section Name of EStab ishment: PANERA BREAD Localion Address: 9702ND 5T NE Cty: HICKORY Baling Name COVELLI ENTERPRISES Billing Address: 9702MID 5T NE Day HICKORY Email Address: Phone: F—]Pennit OTransitional Permit Date: 451212017 Perm ittee: COVELLI E N TE RPRI SES State_ING Zip: 28601 ManagarlPLrson in Charge: KATHY PARKER Gaunty Catawba State: NG Zip: 28601 Status Code: T Fax: Establishment ID: 2018011448 --------------------------- Map #: Parcel IU: ----------___ Emergency Ph ane Number Lata ................. LinQ—_------_--_ Permission is granted to operate a 1 - Restaurant asdetined in G_S_ 13DA-247(1) and 1 SOA -248, Regulation of Food and Lodging Facllties. See permlx requirements In Rules. Trus permit Is not transteraNe and may be revoked f0rfailure to comply wth ell requirements. Waste -Nater systems: QM uricipailCamrnunity [:]Dn-site system Capacty. 90 Gategorf 4: ❑t 1❑ Q Water Supply: QM uricipalIC3mmunity 70n -site System PushcartlNotflie Food Unit ope'ating in conjunction with Restaurent Or COMM SSa-+ NRme an0 ID number ConditionalRemarPs: 6atatli9hrrant assigned to: I806-Seors, Luke [:]Attachments Transitional Permit Conditions `his hermit shell sxpirg 0i 1111W017 and is not ranewa4le. All non-Com[-lian, items listed herein and 0n attached Gages (if applicabla) must n -e c5mdeteJwiihin ] 90 0180 days days. This astablishmant mist close if all noncompliant mems are not corrected by the expiration da'e. Received By. M anagerlPerson in Charge Tit a, nate 0512312017 Sioned B:j�er3l : r REHS#: 1896 -Sears. Luke Date: D5123f2017 iv ion of Public Health Purpose: St 130, iv 8(b; states "10 establishment shall rommenoe or cant nue apeyatian wathaut a:��ut or transi7on 1 hermit issued by the Depamx�ent_ The pfrniit or transiaonal p=t shall be issued to dhe oxner or operator of the establiskmEnt and shall not be ransferable_ If the establishment is leased, the pemit or transitional permit stall be issued to the lessee and shall not be transferable. If the locatian of an establishment changes, anew pennii shall be obtained for the establishment_ 4 pemiit shall be issued only %hen the establishment satisfies all of the raquimnerhts of the rules_ The Commission shall adopt rules e=blishing the requiremems that must be met before a transitional venin may be issued, and die penoc for which a trans:tonal perm imy be ismued. The Department may also impose e�rsiciiEtnis rni [heissuairceafa p�uattn uansiritmal prrnnt in acezncianuexitt sults ad,�pred t*ti• rile Curiuenssian_ A pnnat rn uansitioual prr�rnr shall tie irunediarely revoked in accordance with G -S_ 1304-23(d) for failure of the establishment to maintair a minirrum grade of C_ A pemrit or trarsiticnal pernit may otherwise be suspended or moktd in acccrdanee with G -S_ 130.k-23--" Preparation: Loral emimnmhental health specialists shall issue a permit every time a change in pemnit status is indicated. Prepare as onXnal and one copy for. 1.4ng}nal to be left wah the vane: or operator. 2. Copy for the local healthdeputrnrnt. Disposition: Please refry to Records Retention and Dispamit on Schedule 8B.6., for CounmDistnrt Health Departn:entswhizn ispub.ished bvthe North Caolina a vinimofArchives& History. AddiLanai fomes may be ordered from: Emironmental Health Semor:, 1631 Mail Service Center, Raleigh, -NC 2 7699 2, [Courier 52-01-4]) EHS 1341 (revlsec 07112) Eryiron mentaI Health Section Comment Addendum -Attachment Establishment Name: PAN FRABRFAD Location Address: R70 2ND ST NE City: HICKORY State: NC County: Catawba Zip: 28841 Wastewater System: MunicipaVComnunity C) On-site system Water Supply: (j) Munnipa VCammunitf C, On -Site System Permittee: COVELLI ENTERPRISES Telephone: GonaitionsiRemarKS rcontinueay Nan-Corr:pllant Items; Establishment ID: 301M11448 Date: W23J2017 Status Code: T Category #: IV