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Transitional Permit Conditions., Petrn�tExpire&
Coftdillons,Remairks
Establishment Assigned To:
1654-Huffman, Jason
1654-Huffnian, Jason 1 0 1 1 a k a 0 1 2
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Title Date:
NC Department of Environmental & Natural Resources [j]New [—]Transitional
Division of Environmental Health
Date. 11012M12
I
Name of Establishment BERLINERKINDL GERMAN RESTAURANT Permittee:BERLINERKINDI.
Location Address: OK70SERFEST HICKORY Manager -Person in Charge:
City, HICKORY State! NC Zip: 2860,1 —County, 18
Billing Name' BERLINER KINDLGERMAN REST Status Code I
Billing Address: 121 BROADWAY Establishment ID, 2018730602
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City: BLACKMOUNTAM State : NC Zil)28711 N1 a p #: . ... . . . . . . . . . . . Parcel Q — — — — — — — — — — — — -
EnriailAddrassLet..—_--_®--®®_—_—. Lonj -----__—®_____--
Phone
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Emergency Phone Number:
Permission Is granted to operate a 73 -Temporary Food Establish on ent. as defined in 0,5, 13OA-247(l) 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: municipatrcornnhunity HOn-Site System Capacity: Category #1 91 a
Q
VVater SupplyIN unicipah'Cominhunity On -Site System rig
K
PumIncortfMobile Food Unit operating in conjunction with:
Restaurant or Commissary Narr'i andOV656`67 — — — — — — — — — —
�and itior`iRegi
Establishment assigned to: 1654-Huffman, Jason
[:]Aqac,hrn eats
Transitional Permit Conditions
This pprrpil $Insill e, gpire on no I$ npwal*lAll ngr-c p, mplia li$ n mQj rp rit itp h9r9in and, p o
@ppIlcqIoIe) must be completed within D90 [1180 days days. This estalallshrment must close if all noncornpilant ltem5- are not corrected by the
expirotion date,
Received By: Title Date: 10MM12
ManagefFerson 1Charge
Signed: R 0 #: 1654-Huffmain, Jason Dale: 1110MX2012
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D YI n m
Purpose: General Statute 1311T-248(b) ..ence orcontinue operation without apffmit or transitional pernaitissued bytheDcpartrrmt.
The permit ortransition2l permit shall beissued to the ovoneroroperator ofthe establishment and shall notbe transferable. Iftheestablishment isleased, the pernit or
transitional penrut. shall beiss-aecltothe lessee and shall notbe transferable. Ifthclocation o f an establishment changts, a new permit shall be obtained for the
egt2lblishment. A pernut shall teissued only when the establishment satisfies all oftore requirements ofthe rules. The Comt-raission daall adopt rules establishing the
requimmerits thatmust be met before a transitional paint may be issued, and the period far which a transitional pen-xutnmytoisslied. The Departramtarray also invose
conditions an the issuance of permit ortransitionat pffrutin accordance veith rules adopted by the Commission. Apennit or transitional permitshallbe immediately
i-&vokedinaccordance with G-S. 130A-23(d) for failure oftheestablishmentto maintain aminimumgrade of . A perr-nitef t-ansition-alpermit may otherwise be
suspended or revoked in accordance with G. S. 130A-23.." Preparation Local environmental health specialists shall issue a permit every time a changein permit status is
indicated. Prepare anoriginal and one copy for 1. Original to be left vAththeovmerorioperator- 2. Copy for the l o cal health idepartment. Dispositicom Please refer to
Records Retention and Disposition Schedule S.B,6., fbr County[District Health Departmentowhich is published bythe North Carolina Division ofArchives &History'
Additional formsmaybe ordered from Division ofErrv:ironmfntalHealth, 1632 I&il ServiceCenter,Raleighj4C 27699-1632, (Courier f2-0 1-00)
DENR 1341 (revised MOO)
Environmental Health Services Section (review 7M)