HomeMy WebLinkAboutBLA YANG THAO 730551 11 23 11.pdfTime in,
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1 8 Catawba
Email Address:
Fo un —ty*
5-5 - Municipal/Community
3-3 - Municipal/Community NIA
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Water Supply
Wastewater System Rlsk Category
Territory # capacity:
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73 - Temporary Food I
Facility ID E] Existing Facility?
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Opetate a: Status Code
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Parcel 10 #
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pate.
l`iow PushcaTUMobile Food U'ritt op'erating In crini uncin ith:
Transitional Permit Conditions: Permit Expires. E190days 0180dai1is
Non -Compliant items completed by:
CoRditionsJRemarks:
"It E sta b Ilshm ent A ssig n e d To
V LT qvVe, - 1654-Huffman, Jason
wat e, U
1654-Huffman, Jason 1 / 2 3 / 2 0 1 1
EHSID Date:
M anager/Pprson in charge
1 1 3 0 1 1
Title Date:
NC Department of Environmental & Natural Resources [j]New [—]Transitional
Division of Environmental Health
Date. VMiMll
Name of Establishment BLAYANGTHAO Permittee:13LAYANGTHAO
Location Address: 2011 HIMONG NEW YEAR Manac get -Person in Charge: BLA YANG THAO
City, NEWTON HMONG F'AtRGRO State! NC Zip: 28658 —County, 18
Billing Name, BLAYANGTHAO Status Code
Billing Address 6616SIMP SONRD Establishment ID, 2018730551
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City: CHARLOTTE State'. NC Zip: 28216 N1 a p #: . ... . . . _.____..Parcel Q — — — — — — — — — — — — -
Email Addrass Lat — — — — — — — — — — — — — — — . Lonj — — — — — — — — — — — — — — — —
Phone
F ax:
Emergency Phone Number:
Permission is granted to operate a 73 -Temporary Food Establishment as defined in 0,5, 13OA-247(l) and 1311_Au248,
Regulation of Food and Lodging Facilities, See permit requirements in Rules, This permit is nut transferable and may be renked forfailure to
comply,with all requirements.
VV a stewater Sy stems:
� m unicipatrcomnhunityHOn-Site System Capacity: Category#1 R
VVater SuphlMunidpalVCommunity On -Site System 1 a] Q
El K
PuelocortfMobile Food Unit 0P@rM1ih9 in 60njUnCtiOn With!
Restaurant orCommissaryy Name and 0—nW667 ----------
�ond it ion SA egh ark 8:
E sla b lie h no e nt a s9i 9 ne d to: 1654-Huffman, Jason
OPERATE DB-23 THROUGH 08-27-2-111 ONLY
[:]Aqachrn ents
Transitional Permit Conditions
7his pprirpil $np11 p, gpire on no i$ npwal*lp, All ngn-c mplia li$ n I rp , , , , p rit itp .190 ingrgin and, p 0 page , 9 of
applicable) must be cornpletod within D90 [1180 days days. This establishmont rnusl close if all noncornpliant ltem5.. are not corrected by the
expiration date,
Received By", Title: Gate: 1 1J23Q01 1
M anagefFerson in Charge
Signed:
Divisior\uL+_n.y_Vbnmerta H It
Purpose: GenffaiStatute 13OA-248(b)states "Noebttab lament shall commence or continue operation without a permit or transitional permit issued by the Department.
The permit or transitional permit tall be issued to the owner or operator of the establishment and tall notbe transferable. If the establishment is leased, the pernit or
transitional pmnit shall be issued to the lessee and shall not be transferable. If the location of an establishment changes, a ntwpffmitshall be obtained for the
establishment. A permit shall te issued only when the establishment satisfies all of the requirements ofthe rules. The Comrimssion. slaall adopt ntles establishing the
requirements thatmust be met before a transitional permt may be issued, and the period far which a tzanatdonal pen-mtnuyteissued. TheDepaitramt. array also impose
conditions on the issuance of permit or transitional permit in accordance veith rules adopted by the Comraissim. A permit or transitional permit shall be immediately
reerakedin accordance with G S 130A 23(d} far failure ❑Elbe esCahksl°arnenit® maintain atrurumum grade of C A permit trarisitiotxdl perizut may ot-lxersuse be
suspended iorre-eokedinaccordance with (j.S. 130A-23.." Preparation Local environmental health specialists shall issue a permit every time a change in permit status is
indicated. Prepare an original and one copy for 1. Original to be left voith the ov?ner or operator- 2. Copy for the local health department. Disposition. Please refer to
Records Ret ent on and Disposition Schedule S.B,6., fbr C ol.mty[Distri d Health D epartments whi chi s published by the North Cuolina Division ofArchives & Hi Aory.
Additional forms maybe ordered from Division of Environmental Health, 1632 1Aail Scrvice Center, Raleigh, HC 27 699-163 2, (Courier �2-0 1-00)
DENR 1341 (revised MOO)
Environmental Health Services Section (review 7M)
Rs1654-HuffmaDate
n, Jason 1 112aP2011
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