HomeMy WebLinkAboutBerliner Kindl German Restaurant Permit 730722 10 11 13.pl.pdfTime Im I I : 0 0 ETarin rn; Time Out: 1 1: a, 0 A El arnrn Total Time: 20 minutes
I . El p- - p
B E R L I N E R K I N D L G E R M A N R E S T A U R A N T
Name of E stabfishment
H I C K 0 R Y 0 C T 0 B E R F E S T
Address 1,
Address 2:
H I C K 0 R Y
City:
B E R L I N E R
Permittee
N C D 8 6 G 1
State: Zip:
M anager or Person in charge
E] [A ailing Address Same
B E R L I N E R K I N D L G E R Ni A N R E S T A U R A N T
14 ailing N a me
� I B R 0 A D W A Y
1A ailing ,Address I
IJ ailing Address 2
B L A C K M 0 U N T A I N N C .1 8 7 1 1
fifty; State: zip.
Phone Fax Emergency Phone Number
r'.nfnwh�
Email Address:
5-5 - Municipat/Community
Water Supply
0 7 2 a * Enter Last 4 dig�ts only
Facility lD
3-3 - Muni cipalICommunity N/A
Wastewater System Risk Category
Old Facility ID:
F23TREM
3
Lat. Long,
Push Cart or MFU [:]Pushcart [:]M FU
1 8
County #
01
Terrflory # Capacity:
73 - Temporary Food I
-4-20,414iq4�f"0044
Operate a: Status Grade
1 0 1 1 1 0 1 3
Date:
Pushcarliklobile Food Unit operating in conjunction with:Restaurant or Commirs,5ary ID,
0
Transitional Permit Conditions: Pennif Expires: Non-CoF_�9mpliant idays E]180 days
terns completed by;Condition sIR am arks
TO OPERATE 10/11 - 10/13/13 ONLY
Rpm alqc'q
3968
Non -Compliant Remarks Click the checkbox to add non-rnpgarn rerpaAs
I U EHS Signature, M anageriPerson in Charge
2031-Levin, Paige 1 0 / 1 1 1 2 0 1 3 1 0 ty 1 1 ty ) 0 1 3
EHSID Date: Title Date:
NG Department of He a Rh and Human Services [j]Parmit F-]TransitionalPermit
D iv ision of Public I I ealth
Environmentat Hoalth Section Date: 1011V2013
N a of Establishment: BERLINER KIINDL GE MAN RESTAURANT Perm ittee: BERLINER KJNDL
Gly: HICKORY
State - NC Zip: 28601 Managcr/Pcr-,o,n In Chargo:
Billifing N ame- BESLINER K4NDL GERMAN RESTAURANT County
Biting Address. 121 BROADWAY fl
City, BLACKMOUNTAIN State:,NC S ip281111 status Code: I , —
Ernat[Addrtss: Establishment ID, 20190
---------------------------
Phone- — Fax" map, #� - - - - - - - - - - - - - - - - Pareel ID- - - - - - - - - - - - -
Emergency Phone Number Lat- - 3 -------------- . Lon ................
Permission is granted to operate a 73 -Temporary Food Establishment as defined in G.S. 13OA-,247(l) and 1 MA-248,
Regulation of Raid anti Lodging FaCillties. See permit requirements in Rules. 'this permit is not, transferwie, and may De revoked for failuria to
comply wth all requirements.
WastexeaterSysterns; Rmuricovc�rnmunk, [:]Cn-site System Capacty:
categorf #: 91 E ff]
WaterSupply: [E]MuricipaljC)nnruuMty E]On-Site Systern
Fushc3tt'Nobile Food Unitope'ating in conjunvion with ReSTaurEnt Or COMM SSa'y N3Me an —0 IM56J ----------
Cc nd it! on adR em a rk&
E etablishrre nt 3 ssig nod 'to: 2031-Lo,vin, Paige
TO OPERATE I DA I - 10/13,113 ONLY
-------------------------------------------
$itionall Perrn it Condition%
-his permit $hall expire 01 and isnot renewahle, All nn-comrlian, items Batedherein and on attached Rages (if
anali-mblp,) must be cDrnD.leteJwilhln g0,/E] 180 days dais. This astablishnnent mist close if all noncornelimt i,.ems are not corrected had the
expiration da:e.
RP,rP.NPd Py Tit n,
M 3nageriPersun in Charge
nm, 1011112013
Sinned BY: t REHS#: 2031-Levin, Paige Date: 10/11/2013
Z
DivItion -of Public Health
Purpwe;Gene,eri�lSta --ommence orcontinue opefatton without a petmit or tamntionzl prinnit ismed by the Departnaent-
'Me it or tranalnonal petmil shall be issued to the iyxner or Operator of the establistrnent and shall not betramferablt- Ythtestablishment is, based, the permit or
transitonal ptmt shall be issued to the lessee and shall not be =sftrablt. If fie lacatan or an estath stment changes, a ntNv Perm f shall be, obtained for the
establishrntnt- A permit shall be issued Only Nihen fee estabtishmm-m satisfies, all of ihe requirements of the rules - The Cor arnission shad adapt rules CsLblisbing the
requirements du t must be met be -'ore a transitional pernrit may be issued, and 1e period fJbTcN,1nch a trans -Atonal permit may be issued. The Eitparment ma°, a! so impose
revoked in accordance vita G_S_ 1, 30A-23(d) for fiii@nreaf the estabtishnrerrt to maintaira rnmitrorn grade of C_ A permit ix trarsiticnal pertnit mav, of wise to
suTerdtd or revokt.d inacr-cirdaroe, Nkith G_S_ 130A-23--" PreparationLozal err�ironmental htalth srecialists shall issuea permit evtnF time a chan-ge in permit status is
indicated. Prepare an ongmal and one copv for I . On gginal to be left vath iheo-,ime: or operzton 2. Copy for tfe local health deparan-ntDi spamtion: Please refer to
RecoAs Retmtai and D! W-ition S died-ule 8 B 6, for C ountyfDi a tict H.-al th Deparonents vdn zh i a pub;.i gied b,,the North Carolina aa sien ofArzhives & history
Additional forrns may be ord,,md from: Fmircuarritntal. Heaitn, Sector, 1,632 Mail Senice Center, Rafeigh, -_NC 27CP,9-1632, (Couriez 52-01-011
DENR 13,41 (revise 0 07J12)
Ervironment2l Health Section
Comment Addendum - Attachment
Location Address: HICKORY OCTOBERFE-ST
HICKOR'M
ty:
ou n W�A
Wastewater System: (j) klunicipavCornnuniV C) On-Sita System
Water Supply: @ C, system
Permiltee: BERLINER KINDL
gum=
Condlllons/RemarKs ilcontlnue,3):
No n---orrplia it Items;
Data: iotiv2oi3
Status Code:
at gory 4.,