HomeMy WebLinkAboutWindy City Sundries Permt 021470 12 01 17.LS.PDF
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WINDYCITYSUNDRIES
Name of Establishment
11292NDSTNE
Address 1:
Address 2:
HICKORYNC28601
ZIP:
City:State:
DANIELSIGMON
Permittee
Manager or Person in charge
Mailing Address Same
DANIELSIGMON
Mailing Name
11292NDSTNE
Mailing Address 1
Mailing Address 2
HICKORYNC28601
City:State:ZIP:
() -() -() -
PhoneFaxEmergency Phone Number
Catawba
18
County #
Email Address:
01
5-5 - Municipal/Community3-3 - Municipal/CommunityII
Capacity:
Water SupplyWastewater SystemRisk CategoryTerritory #
2 - Food StandsT
Enter last 4 digits only
1470
Old Facility ID:Nodq`sd `9Rs`str Bncd
Facility ID
Map #Parcel ID #
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12012017
Lat.Long.
C`sd9
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PushcartMFU
Pushcart/Mobile Food Unit operating in conjunction with:
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90 days180 days
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//
05302018
Non-Compliant items completed by:
Conditions/Remarks
REFINIGH FLOORS IN PREP AREA.
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3971
Non-Compliant Remarks
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4000
Establishment Assigned To:
1896-Sears, Luke
EHS Signature:Manager/Person in charge
1896-Sears, Luke
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1201201712012017
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Title
Print
NC Department of Health and Human Services
PermitTransitional Permit
Division of Public Health
12/01/2017
Date:
Environmental Health Section
WINDY CITY SUNDRIESDANIEL SIGMON
Name of Establishment:Permittee:
1129 2ND ST NE
Location Address:
HICKORYNC28601
City:State:Zip:Manager/Person in Charge:
DANIEL SIGMONCatawba
Billing Name:County:
1129 2ND ST NE
Billing Address:
T
HICKORYNC28601
City:State:Zip:Status Code:
2018021470
Email Address:Establishment ID:
Phone:Fax:Map #:Parcel ID:
Emergency Phone Number:Lat:Long:
2 - Food Stands
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:1896-Sears, Luke
REFINIGH FLOORS IN PREP AREA.
Attachments
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05/30/2018
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
1896-Sears, Luke12/01/2017
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
WINDY CITY SUNDRIES
2018021470
Date:
12/01/2017
T
1129 2ND ST NE
Status Code:
Location Address:
HICKORYNCII
City:State:Category #:
28601
Catawba
County:Zip:
Municipal/CommunityOn-Site System
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DANIEL SIGMON
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Conditions/Remarks (continued):
Non-Compliant Items: