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HomeMy WebLinkAboutDig and Dogs Permit 040023 12 01 17.SC.PDF am am ::23 minutes 04220445 Time In:Time Out:Total Time: NewTransitional pm pm DigandDogs Name of Establishment 4121BunkerhillSchoolRd Address 1: Address 2: ClaremontNC28610 ZIP: City:State: SamuelWilliams Permittee SamuelWilliams Manager or Person in charge Mailing Address Same SamuelWilliams Mailing Name 4121BunkerhillSchoolRd Mailing Address 1 Mailing Address 2 ClaremontNC28610 City:State:ZIP: () -() -() - 82830265458283026545 PhoneFaxEmergency Phone Number Catawba 1digndogs@gmail.com 18 County # Email Address: 01 5-5 - Municipal/Community3-3 - Municipal/CommunityII Capacity: Water SupplyWastewater SystemRisk CategoryTerritory # 4 - Push CartsI Enter last 4 digits only 0023 Old Facility ID:Nodq`sd`9Rs`strBncd Facility ID Map #Parcel ID # ..// 12012017 Lat.Long. C`sd9 OtrgB`qsnqLET PushcartMFU CIRCUSHALLOFCREAM Pushcart/Mobile Food Unit operating in conjunction with: 2018020008 Qdrs`tq`msnqBnllhrr`qxHC9 90 days180 days OdqlhsDwohqdr9 Sq`mrhshnm`kOdqlhsBnmchshnmr9 // Non-Compliant items completed by: Conditions/Remarks Need to get serv-safe managers class within 210 days after issuance of permit Let EH know schdule of where you will be including when you go out of county please notify that county of operation Bg`q`bsdqr Qdl`hmhmf 3807 Non-Compliant Remarks Bg`q`bsdqr Qdl`hmhmf 4000 Establishment Assigned To: 1711-Carpenter, Scott EHS Signature:Manager/Person in charge 1711-Carpenter, Scott //// 1201201712012017 C`sd9 EHSID C`sd9 Title Print NC Department of Health and Human Services PermitTransitional Permit Division of Public Health 12/01/2017 Date: Environmental Health Section Dig and DogsSamuel Williams Name of Establishment:Permittee: 4121 Bunkerhill School Rd Location Address: ClaremontNC28610Samuel Williams City:State:Zip:Manager/Person in Charge: Samuel WilliamsCatawba Billing Name:County: 4121 Bunkerhill School Rd Billing Address: I ClaremontNC28610 City:State:Zip:Status Code: 1digndogs@gmail.com2018040023 Email Address:Establishment ID: (828) 302-6545 Phone:Fax:Map #:Parcel ID: (828) 302-6545 Emergency Phone Number:Lat:Long: 4 - Push Carts 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 CIRCUS HALL OF CREAM Pushcart/Mobile Food Unit operating in conjunction with: Restaurant or Commissary Name and ID number Conditions/Remarks: Establishment assigned to:1711-Carpenter, Scott Need to get serv-safe managers class within 210 days after issuance of permit Let EH know schdule of where you will be including when you go out of county please notify that county of operation 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. 12/01/2017 Received By:Title:Date: Manager/Person in Charge 1711-Carpenter,12/01/2017 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 Dig and Dogs 2018040023 Date: 12/01/2017 I 4121 Bunkerhill School Rd Status Code: Location Address: ClaremontNCII City:State:Category #: 28610 Catawba County:Zip: Municipal/CommunityOn-Site System V`rsdv`sdqRxrsdl9 V`sdqRtookx9 Municipal/CommunityOn-Site System Samuel Williams Odqlhssdd9 (828) 302-6545 Sdkdognmd9 Conditions/Remarks (continued): Non-Compliant Items: