HomeMy WebLinkAbout100711.GRANNYS COUNTRY KITCHEN.2018730371.JH.pdfTime in, 1 a : 0 0 Ilarn Tinne Out- 1Qarri Total Tirne� 1 minute [ENlew [:]Transitionai
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G R A N N Y ' S C 0 U N T R Y K I T C H E N�
Name of Establis,hrrient
0 K T 0 B E R F E S T
Address",
H I C K 0 R Y N C 0 8 6 0 1
0 ity - I ate: dip:
K E N T C R A N F 0 R D
Perminee
Manager or Person in charge
[:] Mailing Address Same
K E N T C R A N F 0 R D
Mailing Name
P 0 B 0 X 1 1 9 4
M arling Address
I C A R D N C a 8 6 6 6
City: 'Mate: lip:
Phone Fax Emergency Phone Number
0 1 8 Catawba
Email Address: Taunty
5-5 - Municipal/Community 33 - IvIvnicipal/Community NIA 01
Water Supply Wastewater System Risk Category Territory # 0 a pac ity:
,) 0 1 8 7 3 6 3 7 1 73 - Temporary Food I
Facility ID []Existing Facility? 0 Id Facility V Operate a: Status Code
am
Parcel 10 #
Lat. Long,
E_uj_ft_Qmn_R_r_M_F_Q OPushcart [:]MFU
1 0; 0 7 1 2 0 1 1
Date:
`Ton W'
PusticaTtlMobile Food U'nit op'erxi�ing in conlunciRh:
Transitional Permit Conditions: Permit Expires: [:]90 days [:]180 days
Norr-Compliant sterns compleled by;
CoRditionsdRemarks
Establishment Assigned To
k YK I 1 11 V.A VV V ry IT 1654-Huffman, Jason
JH ga u re: M anager/Person in charge
1654-Hson uffman, ja1 0 0 7 / 0 0 1 1 1 0 / 0 7 0 1 1
EHSID Date-, . . . . . . . `71 Title Date:
NC Department of Environmental & Natural Resources [j]New [—]Transitional
Division of Environmental Health
Date . 1(71OM011
Name of Establishment GRANNY'S COUNTRY KfTCHEN Permittee: KENT NFORD
Location Address: OKTOSERFEST ManagerPerson in Charge:
City, HICKORY State, NC Zip: 28601 County: 11018
Billing Name' KENT GRANFORD Status Code I
Billing Address Path BOX' 1194 Establishment ID, 2018736371
City ICARD State : NC Zip: 28666 N1 a p #: . . . . . . . . . . . . . . . Parcel Q — — — — — — — — — — — — -
EmailAddrassLat — — — — — — — — — — — — — — — . Lonj — — — — — — — — — — — — — — — —
Phone
F ax:
Emergency Phone Number:
Permission is granted to operate a 73 -Temporary Food Establishment as defined in 0.5, MA-247(1) and 1311_Au248,
Regulation of Food and Lodging Facilities, See permit requirements in Rules, This permitis nuttransferable and may be revoked forfailure to
comply,with all requirements.
VV a stewater Sy stems: 4 municipatrcomrounity HOn-Site System Capacity: Category #1 R1 a] Q
Water Supply IN unicipaVCcummunity On -Site System El K
PumhcortfMolbile Food Unit 0P@rM1ih9 in Conjunction With!
Restaurant or Commissary Name and0—nW6`67
Conditior`SiRegnarkS:
Establishment assigned to: 1654-Huffman, Jason
OPERATE 10-07-111 THROUGH 10-09-11 ONLY
[:]Aqachrn eats
Transitional Permit Conditions
This pprnnij $np11 e, gpire on no i$ npWalolp, All ngn-c mplia li$ n a Inq not rp , , , , p ant itp .190 h9r9in and, p fjp�
applicable) must be cornpletod within D90 Ell 80 days days. This establishment rnusl close, if all nouncompliant tem5: are not corrected by the
expiration date,
Received By", Title: Gate: 10J0712011
M anagefFerson in Charge
signed:_ RG r-, 16,54-Huliman, Jason — Date 1 MV2011
'&AsiE v intal Health
Purpose: General Statute 130A-24 'b) t s "No establishment shall commence or continue operation vvithoutaperrnit or transitional pamitissued bytheDcpartment.
bei The permit. ortransition2l pieffrat shall Redto the owner ioroperator ofthe establishment and shall notbe transfera'ble. Iftheestablishment isleased, the pernit or
transitional pmnit shall be issued to the lessee, and shall not be transferable. Ifthe location ofanestablishment changes, a newpffrnit shall be obtained for the
establishment . A permit shall teissued only when the establishment satistiesall o f the requirements ofthe rules. The Comrimssion. shall adopt rules establishing the
requirements thatmust be met before a transitional permit may be issued, and the period fbr which a transitional pertmtnaayt e issued. The Depattrnmtarray also impose
conditions on the issuance of perrinit or transitional pffrnit in accordance veith rules adopted by the Commission. Apernit or transitional permitshall be immediately
130A-23(d:)foffailure oftheestabEshmmttomaintain amifitnumgrade ofC.Apeff-nitoft-ansitiofialpam-iitffia7othefvAsebe
suspended iorre-eokedinaccordance with G.S. 130A-23.." Preparation Local en-ouronmental health specialists shall issue a permit every time a change in permit status is
indicated. Prepare an oligInal and one copy for 1. Original to be left with the ovmer or operator- 2. Copy for the local health department. Disposition. Please refer to
Records Ret ent on and Disposition S rhed-We S.B,6., for C ounty[Distri d Health D epaitments whi chi s published by the North Carolina Division ofArchves & Hi Aory,
Additional forms maybe ordered from Division ofEn7ironmentat Health, 1632 l&il Service Center, Raleigh, HC 27 699-163 2, (Courier f2-0 1-00)
DENR 1341 (revised MOO)
Environmental Health Services Section (review 7M)