HomeMy WebLinkAboutFred T Foard Soccer Concession Permit 140215 04 09 13.ls.pdfEHSID
Total Time:Time Out:
Date:
Time In:
Title
Address:
Capacity:
City:State:
Permittee
Name of Establishment
Facility ID Old Facility ID:
Zip:
Mailing Address Same
Mailing Address
City:State:Zip:
Phone Fax Emergency Phone Number
Email Address:
Manager or Person in charge
Water SupplyWastewater SystemRisk CategoryTerritory #
County #
Operate a:
Map #Parcel ID #
Lat.Long.
Status Code
Date:Push Cart or MFU
Pushcart/Mobile Food Unit operating in conjunction with:
Transitional Permit Conditions:
Conditions/Remarks
Pushcart MFU
Permit Expires:Non-Compliant items completed by:
EHS Signature:Manager/Person in charge
Date:
Print
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Attachments
Mailing Name
90 days 180 days
New Transitional
Establishment Assigned To:
Existing Facility?
()-()-()-
am
pm
am
pm
Restaurant or Commissary ID:
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::0109 0115 6 minutes
FREDTFOARDSOCCERCONCESSIONS
3407PLATEAURD
NEWTON NC28658
FREDTFOARDBOOSTERS
NC
18 Catawba
5-5 - Municipal/Community3-3 - Municipal/Community II 01
2018140215 14 - Limited FoodI
04092013
1896-Sears, Luke
1896-Sears, Luke 0409201304092013
Zip:
Received By:Title:
Date:Signed:
Establishment ID:
RS#:
Date:
Permittee:
Wastewater Systems:
Manager/Person in Charge:
Transitional Permit Conditions
County:
Date:
Water Supply:
This permit shall expire on
Name of Establishment:
Pushcart/Mobile Food Unit operating in conjunction with:
expiration date.
Location Address:
City:State:
Billing Name:
Billing Address:
City:
Email Address:
Phone:Fax:
Status Code:
Map #:Parcel ID:
Lat:Long:
Emergency Phone Number:
NC Department of Environmental & Natural Resources
Division of Environmental Health
Zip:State:
Permission is granted to operate a as defined in G.S. 130A-247(I) and 130A-248,
Regulation of Food and Lodging Facilities. See permit requirements in Rules. This permit is not transferable and may be revoked for failure to
comply with all requirements.
Capacity:Category #:
Restaurant or Commissary Name and ID number
Conditions/Remarks:
and is not renewable. All non-compliant items listed herein and on attached pages (if
applicable) must be completed withindays. This establishment must close if all noncompliant items are not corrected by the
Manage/Person in Charge
Division of Environmental Health
Purpose: General Statute 130A-248(b) states "No establishment shall commence or continue operation without a permit or transitional permit issued by the Department.
The permit or transitional permit shall be issued to the owner or operator of the establishment and shall not be transferable. If the establishment is leased, the permit or
transitional permit shall be issued to the lessee and shall not be transferable. If the location of an establishment changes, a new permit shall be obtained for the
establishment. A permit shall be issued only when the establishment satisfies all of the requirements of the rules. The Commission shall adopt rules establishing the
requirements that must be met before a transitional permit may be issued, and the period for which a transitional permit may be issued. The Department may also impose
conditions on the issuance of a permit or transitional permit in accordance with rules adopted by the Commission. A permit or transitional permit shall be immediately
revoked in accordance with G.S. 130A-23(d) for failure of the establishment to maintain a minimum grade of C. A permit or transitional permit 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 change in permit status is
indicated. Prepare an original 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 8.B.6., for County/District Health Departments which is published by the North Carolina Division of Archives & History.
Additional forms may be ordered from: Division of Environmental Health, 1632 Mail Service Center, Raleigh, NC 27699-1632, (Courier 52-01-00)
DENR 1341 (revised 02/08)
Environmental Health Services Section (review 7/08)
New Transitional
0 1 2
3 4
Attachments
90 180 days
Municipal/Community On-Site System
Municipal/Community On-Site System
Establishment assigned to:
04/09/2013
FRED T FOARD SOCCER CONCESSIONS
3407 PLATEAU RD
NEWTON NC28658
NC
FRED T FOARD BOOSTERS
18
I
2018140215
14 - Limited Food
1896-Sears, Luke
04/09/2013
1896-Sears, Luke04/09/2013