HomeMy WebLinkAboutClinton Tabernacle AME Zion Church Closed Sheet 011175 06 30 17.JH.PDFComment Addendum Report
Establishment Name: CLINTON TABERNACLE AME Establishment ID: 2018011175
ZION CH ❑ Inspection ❑ Re -inspection
Location Address: 480 CATAWBA VALLEY BLVD SE 0 Visit
City: HICKORY State: NC ❑ Verification
County: 18 Catawba Zip: 28602 ❑ Name Change
Wastewater System. FAMunicipaucommunity 0 On -Sits system ❑ Status Change
Water Supply: 0 Muni-oipsI/Community ❑ On -Site System ❑ Pre -Opening Visit
Permittee) CLINTON TABERNACLE AME ZION CH
Date: 0 6 1 3 0 1 x 0 1 7
Status Code: B
Category #: III
Email DRAJFREEMAN35@C
Time In: 1 0: mOCo) pm
[I Other Time Out: 1 0; 0 1 0 pm
Telephone: (828) 327-9070 Water Sample taken?❑yes ❑ Na Total Time: t minute
Temperature Observations
Item Location Temp Item Location Temp Item Location Temp
Observations - Corrective Actions - General Comments
ESTABLISHMENT NOT OPERATING
*GC Sod
First
Person in Charge (Print & Sign):
Last
■
First Last
Regulatory Authority (Print & Sign): 9%�Qww_
RENS ID: 1G54 - Huffman, Jason REHS4ffla ber ( ) -
North Carolina Department of Health & Human Services • Division of Public Health • Environmental Health Section • Food Protection Program
DHHS is an equal opportunity employer. ALI
Paget of 7 Food Establishment Inspection Report,3r2613