HomeMy WebLinkAboutberliner kindl 10-7-11 730386GK.pdfTime In 0 3 a Elam Time Out: 0 El8M Total Time 32 minutes
RIPS p �Fc7F1SwtlCrla
B e r I i n e r K i n d I h a r p
Narne of Estalalrshment
o k t o b e r f e s t
Address.
1 C k o r y N C a 8 6 0 1
Clty; State: zip:
a r o n T r u h e
Permitlee
M ailing Address
B I a c k M o o n t a i n N C a 8 7 1 1
tarty; State: (j Zip:
Phone _ Fax _ Emergency Phone Number
1 C atawba
Email Address. County
5- - MurricipaViCommunuty 3-3- MunicipaUCommunity N/A 01
Water Supply Wastewater System Risk Category Territory # Capacity.
1 8 7 3 0 3 8 6 73 Temporary" Food I
;"�N�i�9icrni�4
Facility ICI [:]Existing Facility" Old Facility ID: operate a: Staters Code
❑ ,tt Chm entS
Map # Parcel' ID
1 0 f 0 7 0 1 1
Lat. Long. Elate:
Push Cart or MFU Pushcart [:]M Fu,
PushcartlMobile Food Unit operating in conjunction with:
Transitional Permit Conditions: Permit Expires. 790 days 7180 days
Non -Compliant items completed by:
ConditlonslRernarks
Establishment Assigned To:
1E a-Kain„ tare
EHS Signature: M anagerlPerson in charge
1 7 a 0 1 1 1 7 1 1
EHSID Date' Title Date:
ir�n� r r
NC Department of Environmental & Natural Resources Ej] file F]Tr nsition l
Division of Environmental Health
Date-, 10/07/2011
Name of Establishment Berliner Kindiharo
Permittee-Sharon Trube,
Location Address: Olkiroberfest
Manager/Person in Charge:
City: Hickory State, NC Zip: 28601
County: 18
Billing Narne, SharonTrube
Status Code,
1301.11ing Address: 121 Broadway
Establishment ID 2018730386
----------------------------
City" Black Mountain State _!�C Zip- 28711 -Map#
-- - - - - - - - - - - - - - - - Parcel ID --- - - - - - - - - - - - -
Email Address,
Lit:--_________-___. Lonj,. . . . . . . . . . . . . . . . .
Phone: Fax
Emergency Phone Num:ber,
Permission is granted to operate a', 73 - Temporary Food Establishment
as 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 forfailure to
comply Wth all requirements,
Wastewater Systems: [EmunicipallcommunityE]on-Site system capacity
ategory #:
Water supply. E?AunicipaliCommunfly 0ion-Site System
PushcartfMobile Food Unit operating in conjunction with:
Restaurant or Commissary Name an ________--
condition RJR emarks:
Establishment assigned to: 1655-Kain, Greg
F-lAttachments
Transitional Permit Conditions
This permit shall expire on and is not renewable, Alp non -compliant items listed herein and on attached pages (it
applicable) must be completed within 90 / [:]ISO days days, This establishment must close if all noncompliant items are not corrected by the
expiration date,
Received ByTitle: Date: 1010712011
M 3nageMerson in Charge
Slgned:_ 'A — RS#- Date: 10/0712011
Dryision of Environmental Health
Puipom, General Statute 130A-248(b) states "'No establishment shall commence or continue operatmn vathouta permit ortransitiorial permit issued by the Department,
The permit or transitional petzrail shall be issuied to the o-wrier 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 transble. If thelocation of an establishment changes, a newperinait shalt be obtained for the
establishment- A permit shall be issued onlyuten the establishment satisfies all of the requirements of the rules, The CorruxAssion shall, adopt rules establishingibe
requirements that must be met before atrainsitional permit. may be issued, and the period for vvhich a transitional perrriit imay beislued . The Department may also impose
conditions on the issuance of a permit orbansitional perran in accordancevAth rules adopted bythe CorraWssion. A permit or transitional perrnit shall be inarnediately
revoked in accordance with G, 13DA-23(d) for Mure of the establishment to maintain a mitimum grade of C. A perniit or transitional penrAtmay othm7VVise be
suspended or revoked in accordance with G-S, 13 CA-23. .' Preparation: Local environmental health specialists shall issue a permit every firne a change in permit status is
indicated. Prepare an original and one copy for I - Original to be left with the owner or operator 2. Copy for the local health department. Disposition: Please refer to
Recor* Retention and Disposition Schedule 8.13 A, for C ounty/Distfict Health Delrarbrients vAuch is published by the North Carolina Division of Archives & History.
Additional forms may be ordered from: Division of Environmental Health, 1632 it Service Center, Raleigh, HC 27 699-163 2, (Courier 52-01 -00)
0ENR 1341 (revised 02f08)
Environmental Health Services Section (review 7108:)