HomeMy WebLinkAboutBlack Olive Catering Permit 020344 05 03 10SC.pdfTime 1w 0 1 ' a ')
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Email Address,
County #
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Wastewater
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Let, Long, Date:
EM1h_9!1L9LME_U E]Pushcart EIMFU
Push Cart or MFU Name
Transitional Permit Conditions: Permit Expires. [:]go days [:] 180 days
Non -Compliant Remy completed try:
CondillonsfRernarks
MUST REDO (PAINT) FLOOR BY jULY 1ST 2010
RECAULK AROUND HANDSINK IN KITCHEN BY JULY 1ST 2010
CLEAN AND EWAX FLOORS IN BATHROOMS BY JULY 1ST 2010
WILL USE CAMBROS PROVIDED BY PIEDMONT VENDING FOR FOOD TRANSPORATION
CAN ONLY OPERATE WHEN PIEDMONT VENDING IS NOT IN OPERATION (COOKING FOOD IN KITCHEN)
iztiu 5ignatu e:
1711 0 5 / 0 3 2 0 1 0
EHSID Date.
Establishment Assigned To:
1654
M
M anageriPerson in charge
1 0
Title Date.
NC Department of nvironm ntal & Naturalresources [j]New [:]Transitional
Division of Environmental Ll a h
Date: 05103/2010
Name of Establishment: Black Olive Gatering
Perm itt:Black Clive LLC
Location Address: 1826 Brian Dr NE
Manager/Person in Charge: Steve Cockerhat
City Conover State : NC Zip:23513
otttTty, 1
BillingNarrie, BlackOlivel-I-C
Status Code. I
hng ,address: PO Box 154
Establishment IQ 2018020344
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y: Conover State, NC Zip 2,8613
Map # - — Parcel ICI:
Email Address:
Let :_-_-----_-----.L nj,................
Phone, {1128} -i 1 Fax;
Emergency Phone Number (828)228-8198
Permission is granted to operate a 2 - Food Stands
as defined in C.S. 1311-247(l) 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.
Wastewater Systems; uniciparlCommunity On -Site System Capacity:
Category
Water Supply: System
RunicipaliCommunflyHOn-Site
Pushcart+Mobi8e Food Unit operating in conjunction with:
Restaurant or Commissary Name and try number
Conditions..Q ernarRs:
Establishment assigned to 1554
-MUST- 15i5(PA_lNT)FLMR'BYj0LYIST2010
.:-
'this permit shall expire on and is not renewabte, nil non -compliant items listed herein and on attached pages (if
applicable) must be completed withm go 180 days days, This establishment must close d all noncompliant items are not corrected bye the
expiration elate.
Received Ey_)�i , Title, Date; 0510302010
�t�aetf'ersun in a� ,
SignedrS : 1711 Bate 051g3+''2g1g
Divis ironinenJfJHec`� h..
PurposeGeneral Statute, 130.4-343tb states'\o establishment shall commence, or continue operation oul oast a Permit or transitional permit i ssued by tare Department.
The Permit or transitional permit shall be issued to the oilmer or operator of the establishment and shall not be transforable. If the establishment is teased, the permit or
transt
donal permit shall be issued to the lesw and shall not be transferable, if the location of an establishment changes, a taeas • rnit shall be obtanisil for the
establishment, 4 permit shalt be, issued only when the establishment satisfies all of the requirements of the rules The Commission stall adopt pries establishing the
requirements that must be, met before, a transitional pennit may be issued, and the period for vviuc t a tramitional permit may, be issued. The Depamuent tray also impose
editions on the issuance of perript or transitional pennit in accordancevilth rules adopted by the Commission . A permit or transitional pernsit shalt be immediately
revoked in accordance wth . 13OA-23idj for failure of the establishment to radiation a minimum grade of C. :A permit or transitional permit rotor offiervuse be
suspended revoked in accordance with G.S. 13OA-23. ' preparation: Local environmental health specialists shalt issue a permit every, time a change in permit status is
indicated_ prepare an onginail and one copy for: 1 On ginal to be left with the owner or operator- `3 Copy for: the beat health department. Distrostiorr P'lease, refer to
Records Retention and DiVosifiorr Schedule k .6.s for CountyCistnct Health Departmentswinich is published by the'Node% Carolina l �vision ofArchiv s & History.
Additional forms maybe ordered from, Division of Enviromateatal Health, 1632.%tail Service Center, ateigh, N 37609-1632, (Courier 32-0-f0)
f3ENR 1341 (revised 021081,
Environmental Health Services Section (review 7108)