HomeMy WebLinkAbout7-Eleven 36071 011261 Permit 02 11 13.sc.pdfTime In 0 1 a 0
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Name of E stabliShment
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Permittee
T u I i e
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M anager or Person in charge
[:J Mailing Address Same
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M ailing Name
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M ailing Address
D a I I a s
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City;
state: Zip:
( 8 28 4 5 9
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( 97 2 8 J 8 7 6 08
Phone
Fax
Emergency Phone hl,,%,,
1 8 Catawba
Email Address:
county #
5-5 - Municipal/Community
3-3 - Muni cipaUCommunity
11 01 8
Water Supply
Wastewater System
Risk Category Territory # Capacity:
,2 0 1 8 0 1
1 2
6 1
1- Restaurant I
Facility ID [—]Exisfing Facility?
Old Facility ID:
Operate a: Status Code
DAttachments
Map #
Parcel ID #
0 .1 / 1 1 0 1 3
Lat.
Long.
Date:
Push Cart or MFU []Pushcart
[:]M FU
PushcartlMobile Food Unit operating in conjunction with:
Transitional Permit Conditions: Permit Expires:
ConditionsfRernarkS
EFm SignaturJ:
1711 -Carpenter, Stott 0 2 / 1 1 / a 0 1 3
EHSID Date:
Restaurant or Commissary 10;
090days 0180clays
Non -Compliant items completed by:
Establishment Assigned To: J �
1711 -Carpenter, Scott
M anageriPerson in charge
. . . . . . . . . . . . . . . . . . . . . . 0 1 1 / a 0 1 3
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Title Date:
NU DeDartment of Envionnental & Natural Resources [j]h�ew F_]Transitional
Dk,ision of Environmental I lealtl
-
Date02111�2013
N am e o f E stab i shm e nj- 7-Eleven #' 36,071 P erm itte e - 7-Eleven Inc
Location Address Wi7N0Xfr,1rdSt ManagerPerson in Charge: .1tilipPiemp
City: Claremont 6tate I No 1p: 26610, coun-y: 'a
Bi ling N am e, 7 Eleven Inc Status Code I
Billing Address: 1722 RGuth St Suite 1000 Establishment ID, 2019011261
City: Dallas Stag :TX Zir): 75221 Map Daniel ID: - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Email Address. Lal - - - - - - - - - - - - - - - � Ljriy . . . . . . . . . . . . . . . . .
Phone: W28) 4 tc9-1226 _Fax: E r-i e rg envy :1hone N um b 9 r: (912) 828-itsW
Permis�sion is granted to operme 8 1 - Restaurant 2)s defined in G,S, MAu247(1) end 12OA-24G,
Peculation of Fond and Lodqing Facilities. See permit requirements in Pules. This permit is notIran sferaole and maV be revoked forfailure to
comply -vv th all rE q ui,e ments,
W o otemato r Oyote ma: M ur ic ip n IfC )m mu n ity System Systecapacty: 8 Catogore 0'.
Water Suppl� IM uric1paYC)mmunityHon-8it0 System
PushcirtiN obile rand Unit opp,afing in conjuncion with
Restaurant or COMM SSaly Name and l5_1GMCeT
r r nd fin n ajR Pm a rliA,
Establishment assigned V 1711-Carpenter, Scott
At@ chm ents
Tr ns Ition all P orm It C ond Iti on s
-his permit shall expire Qi amid is not ren owe ble. A 11 n o n- GQ mr liq , n, items listed herpin and on attached �aqes (it
a op li, a b P.) must se c 3 m plete J within 90 / []l 9Q days daws. This establishment mist close if all noncompliant i:ems are not corrected loi the
expiration da7e,
por.p.iVP11Ry
viana;iefF,erson in charge
UM
n;;tp, 02111f2013
n
Signed: !s 1.
RE #: 1711 -Carpen,er, Scott Date: 0,2111/2013
Division of FmMronmentll Health
Purpose: General Statute 130A 2,'g(b' , otat5i; "No ectablohrnmt ohall _-o=erice or continue operation vathout a pennit or ttannuorial permit jo-oued by the Department.
The permit or transitional permit shall beissueilto the owner or operator of the establishment and shall not be mrifferabte. If the establishment is 12ased, the perrfft or
transitonal pemut shall be is3uedto the lessee and shall not be transftiable. If he locaton of an estathshment dhuges, a newpernut shall be obtained for tLe
establishment. Apermit 3hallbeissue lorityv,?hmt-ieestablistmmt satisfies all of,,herequirffncnts cfthcrulcs. TheComrnission shall adopt rules establishing the
requirements that must be met be. -ore a transitional -jernit maybe issued, and the peno6 fbrwMuch aimns.tionalpamtrnaybeissuel. The Deparlmeff, may also impose
LUiLliLuns un Lhuissudnuu ufd puml, UI 1j:i1lbalaullal Iii:711jil, in dL;UUIL!dIi1XVAlJ. lUlUS dL1JPlUa by LIX CUMHASSR111. A IRAI1111, J1 11-d1Lih.1JHd1 Ptaillil, slldll bu ii-nar-diaLdy
rev okc J. in accordanc e with G. S. 13 OA -2 3(d) for failure 3 f the estabh Elament to maintair. a rnirlirrum grade of C. A p errait or trar siti cnal p ermit may otaerwi se to
su sp erded or revoked in accordance with G. S. 13 OA- 2 3.. " Preparation Lo:al environmental health specialists 3hall issue a pennit every time a change in permit status is
indicated. Prepare as ori2rn and one copy for. 1. Origimil to be leftwith she owner- or operator. 2. Copy for tLe local health departmmt. Disposition. Flease refer to
Records R ftent. on and Eli sp ositi on Schedule 8.13 .6.. for -_ ounty/E)i strict H m1th Departments whi:h i s pub.i shed by the North Ca: olinaDimsion o fArchives & Fi story.
A Iditionai forms may be ord--red. from: Diui si on of Znvironracntal Health, 1632 Mail S ervi ce C enter, Raid gh, NC 2 7 6 9 9 -16 3 2, (C ouA er 5 2 - 01 - 0 Q
D E V4 R 1.341 (revised 0 2fO8)
E ry iron m enta I Health 8 e ry c e s Section (review M 8)