HomeMy WebLinkAboutBla Yang Thao Permit 730338 11 24 10.KM.pdfTime W
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V"ater Supply
Wastewater System Risk Category,
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.1 0 1 8 7 3 0 3 3 8 73 - Tempofary Food
Facility lD [] Ex isting F acildy? Did Facility 11 operate a Stalus Code
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EM-S-b-Q--3A-0-r-M-F-Q []PUShCaft [:]MFU
Push Carl or M F U N ame
Transitional Permit Conditions, Permit Expires: E]qodays [],180 0ais
Non-Comphant Qems COMPNIted by'�
CondibonvRernarks
'TO OPERATE FROM 11125-28110 ONLY
ENE Sigift;tuire,
2259 11/24/2010
EHS11) Date:
Estalahshmenl A ssgeed Trr;
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M anagerlPerson in charge
# Title Date
N C Department of Environmental & Natural Resources [ENew [:]Transitional
Division of Environmental Heafth
Date: 1112412010
Name of EstabfishnienL�� if4&V Tit .., perMiltee. BLA YANG THAO
Locafion Address, ROICKY FORD RD ManagerrPerson In Charge:
City: NFWTON
Stat e,_�_C Zip. 286M CountyLL8
1311ingplame, BLAYANGTHAO Status Code- '
Les,S, 6616 SIMPSON RD 2018730338
611ing Addr Establishment U ---------------------------
GAY'� CHARLOTTE
State, NC Z ifT, 28216 Map te ---------------- Parcel ID -------- r ------
Email Address: Lat ----------------- . Lon .................
Phone- Faxergency Phone Number:_
Permission is granted to operate a 73 - Ternpomiry Food Establishment as defined in 130A.,247(l) and 130A-248,
RegOation 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.
'A'asnawaler S'lostems: 1 MunrcipaPComrnunqly *'On-sfle System Capacdy: Category Ar:
Water Supply MunmittauCominvni *On -Silo System
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Pushcarighlobde Food Unit operating in conjunchon with, Restaurant or Commissary Name any r nUrR&J -----------
CondiiOnark eras aros:
EstablishmeM assl9fled to: 2259,
This pennit shall expire on and is not renewaWe AH non-crrmrriranl items !rated Won and on attached pages (it
appkablel must be compteted within 0,90 180 days days. This establishment must close if Mir noncompliant items are not corrected by the
expkation date,
Received By Toils: Date1112412010
r1ngellmm in _Ch.,ge
2259 Signed: 1112,412010
rsiFa�oSiDate:
KE41'e, Mn�rne
Pyntrose,Generall$taraio 130A-248(b) states -No establishment, shall rdstrintence or continue ryperabon without a permit or transitional permit issued by the, Deparumni.
The permit or transitions! pennit shall be issued to the ov%rrsr Dr operalor of the establish and sha-H not be hans&rabk,. If the establishment is leaved, the per it or
vartsit'lotial Permit: shall he issued to the 14,sw and shall not be trmsferable- If ilit, location of an, "ablishmena changms, a, vewpennii shall be WaiiiM, for the
establislunent. A permit shall, be imsied onlyxitim the establishment safisfes 31.1 of the, requirements of the rules, The Curnnnymon shall adopt rules ea-ablislimS the
requirenrents that must be met before a transitional permt may issued, and the, pen od far Much a transitiarm1pemut may, be issued, The Department rfay also impose
conslih ors; on the Issinmce of a pemV or tra"natt OTW perimit ai accordance mub stles aj opted by the: Comnh ssi on, A penitt or cawetiorril, perriniT shall N in mo4ately
revokedin, acccrdancemthG.S. 130,A-23(d) for fiflure of the mablishmentro mwntain amnimunagrade of C, A pertrut at transitional p ffmitmayothemmse be
mspended orrevark-tcl in accordance'!cute G_S_ 130Ar 23_'Preparaftoni Local enrincrimenW hoalth specialists shall issue apmnit evmnine a grange in permit statirsir,
irid, cared, Prepare, an original and we copy for. 1, Or' gimil to be left v%i 0 the oyter or operator, 2, Cisjssx,' for the local health ritpartmew, Dispostioz Pleat rek to
Records Retetrum and Disposrhon Schedule 8B.6, for Counw-District Health Depa= eats saki ispublished by the North Carolina Division GfArchives & Hisrory
Additional, forms mav, be orderes! *om Di%ision of EnNi.ronnointal Health, 1,632 Mail Senicr Center,, Raleiggh,'\(f. 2,7699-1632, (Couner 52-01-00)
I)Er,,,IR 1341 (revised, 02,,108)
Environmental Hea"h SeNdces SecOon (review 7108)