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HomeMy WebLinkAboutEats on the Street Permit 030095 12 18 17.SC.PDF am am ::28 minutes 02170245 Time In:Time Out:Total Time: NewTransitional pm pm EatsontheStreet Name of Establishment 7433rdStNE Address 1: Address 2: HickoryNC28601 ZIP: City:State: OntheStreetEatsLLC Permittee BobSteiger Manager or Person in charge Mailing Address Same OntheStreetEatsLLC Mailing Name 7433rdStNE Mailing Address 1 Mailing Address 2 HickoryNC28601 City:State:ZIP: () -() -() - 8283030057 PhoneFaxEmergency Phone Number Catawba 18 County # Email Address: 01 5-5 - Municipal/Community3-3 - Municipal/CommunityII Capacity: Water SupplyWastewater SystemRisk CategoryTerritory # 3 - Mobile FoodI Enter last 4 digits only 0095 Old Facility ID:Nodq`sd`9Rs`strBncd Facility ID Map #Parcel ID # ..// 12182017 Lat.Long. C`sd9 OtrgB`qsnqLET PushcartMFU Pushcart/Mobile Food Unit operating in conjunction with: Qdrs`tq`msnqBnllhrr`qxHC9 90 days180 days OdqlhsDwohqdr9 Sq`mrhshnm`kOdqlhsBnmchshnmr9 // Non-Compliant items completed by: Conditions/Remarks PLEASE REPORT TO LOCAL ENVIRONMENTAL HEALTH DPEARTMENT PRIOR TO DAILY OPERATION ON TIME AND LOCATION AND TO OUT OF COUNTY ENVIRONMENTAL HEALTH OFFICES Bg`q`bsdqr Qdl`hmhmf 3849 Non-Compliant Remarks Bg`q`bsdqr Qdl`hmhmf 4000 Establishment Assigned To: 1711-Carpenter, Scott EHS Signature:Manager/Person in charge 1711-Carpenter, Scott //// 1218201712182017 C`sd9 EHSID C`sd9 Title Print NC Department of Health and Human Services PermitTransitional Permit Division of Public Health 12/18/2017 Date: Environmental Health Section Eats on the StreetOn the Street Eats LLC Name of Establishment:Permittee: 743 3rd St NE Location Address: HickoryNC28601Bob Steiger City:State:Zip:Manager/Person in Charge: On the Street Eats LLCCatawba Billing Name:County: 743 3rd St NE Billing Address: I HickoryNC28601 City:State:Zip:Status Code: 2018030095 Email Address:Establishment ID: (828) 303-0057 Phone:Fax:Map #:Parcel ID: Emergency Phone Number:Lat:Long: 3 - Mobile Food Permission is granted to operate aas defined in G.S. 130A-247(I) and 130A-248, Regulation of Food and Lodging Facilities. See permit requirements in Rules. This permit is not transferable and may be revoked for failure to comply with all requirements. Capacity:Category #:012 Municipal/CommunityOn-Site System Wastewater Systems: Water Supply:Municipal/CommunityOn-Site System 34 Pushcart/Mobile Food Unit operating in conjunction with: Restaurant or Commissary Name and ID number Conditions/Remarks: Establishment assigned to:1711-Carpenter, Scott PLEASE REPORT TO LOCAL ENVIRONMENTAL HEALTH DPEARTMENT PRIOR TO DAILY OPERATION ON TIME AND LOCATION AND TO OUT OF COUNTY ENVIRONMENTAL HEALTH OFFICES Attachments Sq`mrhshnm`kOdqlhsBnmchshnmr This permit shall expire onand is not renewable. All non-compliant items listed herein and on attached pages (if 90180 days applicable) must be completed withindays. This establishment must close if all noncompliant items are not corrected by the expiration date. 12/18/2017 Received By:Title:Date: Manager/Person in Charge 1711-Carpenter,12/18/2017 Signed By:REHS#:Date: Division of Public Health Purpose: General Statute 130A-248(b) states "No establishment shall commence or continue operation without a permit or transitional permit issued by the Department. The permit or transitional permit shall be issued to the owner or operator of the establishment and shall not be transferable. If the establishment is leased, the permit or transitional permit shall be issued to the lessee and shall not be transferable. If the location of an establishment changes, a new permit shall be obtained for the establishment. A permit shall be issued only when the establishment satisfies all of the requirements of the rules. The Commission shall adopt rules establishing the requirements that must be met before a transitional permit may be issued, and the period for which a transitional permit may be issued. The Department may also impose conditions on the issuance of a permit or transitional permit in accordance with rules adopted by the Commission. A permit or transitional permit shall be immediately revoked in accordance with G.S. 130A-23(d) for failure of the 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-23.." 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/District Health Departments which is published by the North Carolina Division of Archives & History. Additional forms may be ordered from: Environmental Health Section, 1632 Mail Service Center, Raleigh, NC 27699-1632, (Courier 52-01-00) EHS 1341 (revised 07/12) Environmental Health Section Eats on the Street 2018030095 Date: 12/18/2017 I 743 3rd St NE Status Code: Location Address: HickoryNCII City:State:Category #: 28601 Catawba County:Zip: Municipal/CommunityOn-Site System V`rsdv`sdqRxrsdl9 V`sdqRtookx9 Municipal/CommunityOn-Site System On the Street Eats LLC Odqlhssdd9 (828) 303-0057 Sdkdognmd9 Conditions/Remarks (continued): Non-Compliant Items: