HomeMy WebLinkAbout101411.SMOKIN MOUNTAIN BOYS.2018730435.JH.pdfTime in,
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City:
M_ate zip.
Phone
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Emergency Phone Number
1 8 Gattiwba
EvnajlAddress:
6-6 - On -Site Suppty
323 - Municipal/Community
Waste wate r System
M
01
Territory # capacity:
a 0 1 8 7 3 0 4 3 5 73 - Temporary Food I
FacilityD [:]Existing Facility? Old Facility V Operate a: Status Code
DAttachiments
M ap # Parcel 10
1 0 / 1 .3 1 2 0 1 1
Lat, Long, Dzfle�
E_UJh_QA_n_0_r__MF_Q [:]Pushcart [:JMFU
Pushcart mobile Food Unit operating in conjunction with:
Transitional, Permit Conditions: Permit Expires: [:]90 days [:]l 80 days
Non -Compliant items completed by;
CoRditionsJRernarks
Establishment Assigned To
I IVI I 1654-Huffman, Jason
Na SiVure, M anageriPerson in charge
1655-Kain, Greg 1 0 / 1 4 0 0 1 1 1 0 / 1 4
EHEH I Ilatea 7" Title Date:
NC Department of Environmental & Natural Resources [j]New [—]Transitional
Division of Environmental Health
Date. 1101312011
Name of Establishment SMOXIN MOUNTAIN BOYS Permittee: BOBBY ETTERS
Location Address: 2330 DAVID BAPTIST CHURCH RD Manager -Person in Charge:
City, KINGS MOUNTAIN State Nr_. Zip: 28086 —County, 18
Billing Name' BOB BYE —TT ERS Status Code I
Bill ingAddress: 2330 DAVID BAPTIST CHURCH RD Establishment ID, 2018730,435
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City: KINGS MOUNTAIN State : NC Zip: 28086 N1 a p #: . ... . . . . . . . . . . . Parcel Q - - - - - - - - - - - - -
Email Addrass Let---_-_®--®®_®--. Long - - - - - - - - - - - - - - - - -
Phone
F ax:
Emergency Phone Number:
Permission is granted to operate a 73 -Ternporary Food Establishment as defined in 0,5, MA-247(1) and 130A.248,
Regulation of Food and Lodging Facilities, See permit requirements in Rules, This permit is nut transferable and maybe revoked for failure to
comply,with all requirements.
VV a stewater Sy stems: A, i-h municipatrcomunity WOn-Site System Capacity: Category #1 M a
W] Q
ater Supply nN unicipah'Comrinunity On -Site System El K
PuelocortfMobilo Food Unit operating in conjunction with:
Restaurant or Commissary name and15-nUrF6`67
Conditior)SiRegnai`118:
Establishment assigned to: 1654-Huffinnain, Jason
OPERATE 10-14 THROUGH 10-16-11 ONLY
[:]Aqachrn eats
Transitional Permit Conditions
71his pprnnij $npI1 e, gpire on no I$ net rp npwal*lp, All ingn-c mplia li$ , , , , p rit hp 190 hpirgin and, pn a pa9@5 of
applicable) must be cornpletod within D90 [:]l 80 days dRyS. This pi;tablishrront must close, if all nouncompliant item5.. are not oorrocled by the
expiration date,
Received By", Title: Gate: 1OJ1412011
M anagefFerson in Charge
Signed: ( O'W I Ma) RG r-, 1655-Kain, Greg- Date 1 W141201 1
Df Eby iro rtal Health
Purpose: GenrA-at Statute 130A-249(b) silltv"No establishment shall commence or continue operation without apermit or transitional permitissued bytheDcparLment.
The permit ortransitional permit shall beissued to the owner ioroperator ofthe establishmentand. shall notbe transferable. Iftheestablishment isleased, the permit or
transitional permit shall bcissued tothe lessee and shall not be transferable Ifthe location ofanestablishment changes, a ntwperrrat shall be obtained for the
egt2blishment. A permit shall teissued only when the establishment satisfies all ofthe requirtments ofthe rules. The Conumsion daall adopt rules establishing the
requirements thatmust be met before a transitional paint may be issued, and the period for which a tmnoittorialperrxitnmytoisslied. TheDepattramtarray also impose
conditions an the issuance of permit or transitional permit in accordance veith rules adopted by the Comcnission. Aperinit or transitional pemmtshall be immediately
r&vokedinaccordance with G_S. 130A-23(d)far failufeoftheestabashmmttomaintain amifiitnumgrade ofC.Apermit eftransitiofi-dlpam-iitmay othefvAsebe
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 owner or operator- 2. Copy for the local health department. Disposition. Please refer to
Records Retention and Disposition Schedule S.B.6., fbr Col.mty[District Health Departments which is published bythe North Carolina Division ofArchves &HiAory,
Additional forms maybe ordered from Division ofEnvironmental Health, 1632lEilSeisnceCe!nter,Ralcigh,r4C27699-1632,(Courier�2-01-00)
DENR 1341 (revised MOO)
Environmental Health Services Section (review 7f08)