HomeMy WebLinkAboutB & B Outdoors 730784 08 21 14.gk.pdfTime in: 1 0 4 6 : IV am Time Out 1 1 : .1' 0 ER any Total Tjme. 34 minutes
El pm - - opm XNew [:]Transitional
B A N D B
Name of Estaotishment
0 L D S 0 L D I E R S
Address 1:
Address 2:
N E W T 0 N s C D 8 6 5 8
Cite; State, ZIP;
B R E N T B U L L A R D
Permittee
M anager or Person in charge
E] Mailing Address Same
B R E N T B U L L A R D 5
M ailing Name
P 0 B 0 X 5 1 7 1
M ailing Address 1
Mailing Address 2
N M Y R T L E B E A C H S C .1 9 5 9 7
tarty � State: yy ZIP:
Phone Fax Emergency Phone Numder
1 8 C atawba
Email Address: County #
5-5 - Municipal/Community 3-3 - Muni cipaUCommunity N/A 01
Water Supply Wastewater System Risk Category Territory # Capacity_
0 7 8 4 440 Enter last 4 dlgis only 73 - Temporary Food I
Facility to 0 W Facility ID: Operate a: Status Code
M a P # Parcel' D #
0 8 1 0 1 4
LatLong, Date:
Push Cart or MFU [:]Pushcart E]MFU
PushcartlMobile Food unit operating in conjunction with Restaurant or CommissarytD.,
F-190 days E] ISO days
Transitional Permit Conditions: Permit Expires: Non -Compliant items completed by:
Canditio n sIR em arks
Non -Compliant Remarks
Estratlishment Assigned To�
1655-Kain, Greg
EHS Signature-,
1655-Kaln, Greg 0 8 1 f 2 0 1 4
EHSID Date:
Title
ElGlick the checkbox to add non-compfiant remarks
M anager/Person in charge
0 8 / .2 1 0 1 4
Daze:
N G Department ot Heath and Human Services [j] Perm it F —]Transitional Permit
D itis,ian of Public I I ealth
Environmontal Hu,alth Suction Date: 0812V2014
hauls cifEstablishrnent; BANDB P emn ittee: BRENT BUIL LARD
40IM403mis
Cty:: NEWTON
Biling Name BRENTBULLARDS County Catawba
Filing Address FAD BOX5171
City- IN MYRTLE BEACH State:ISC Zip: 29597 Status Code.
E m a it Add re ss: EstabliSrhment Q 2018730784
---------------------------
Frl Fax: map #: ------ -------- . Parcel 11), -------------
Emergency Phone Number Lot..------.------.. LanT ................
Permission: is granted to operate a 73 - Temporary Food Establishment asdefined irliGS 13OA-247(t) and 1 3OA-248,
Regulation of Fwd and Lodging F , See permit requirements in Rules, this permat is not transferaole and may be reioked for failure to
comply wthall requiTements.
Wastewater Systerns; [Em uricouc)rnmunity [:]On -site System C cipa c ly:
Calegoq #: 91 E ff]
Water Supply: [flM uricipallCmrrmnjty Elon-site system El HI
PushcvtiNobile Food Unit ope'afing in conjunvion with -'7
Re staurSnt Or CM OM SSa'y Name an3iUr;aT - - - - - - - - - -
CcndjtionVRernarks:
F-stablishrrent assigned to: 1666-Kain„ Grog
AttaChnnents
Tran%itional Perm it Conditions
-his Vermit shall exDjre Qi and isnot renewable. All nzri-comrlian' ileme; lifted herein and on allaChed 7a,clas (if
211akable) must de c;Drnialete J within 90 / [:]180 days days. This establishment mist close if all noncomaliant items arc not corfected be the
expiration dwe,
Rore,Ned Ry Tits
M 3nageriPerson in Charge
n,t,- 08,2112014
Signed BY: RE,HS#: 1Kain, Greq Date: 01121/2014
DIVI's,lion of Public Health
Purpaw General Statute 130,& 24,8(16; states "No -,Otablist nhall mmmenw cc coolinueoperatLon without a pmnit or tmnsitionzl permittissued by the Ek-lewftrimt-
'Me permit or transitional peirrut lialt be, issued to the vxmer or ator of the establisl:rnent anti shall not be transfamble- If flitestablirlunent is Itased, the pffmt or
transitonal peinnit shall be i ssued to the ltswe and shall not be transkrable.. If 'he location of an e stabli Flunent zhangges,a now pt,=_ i shall be obtained for the
establishnaend - A peTmit shall be issued ohly, N�Iiem the establishment satisfies, all of the, requireinents cf the soles_ The, Commission shall adopt rules establishing the,
requirements that must be mtt befcce i transitional m. mt may be issued, and the, penod for Aluch a transnonal peirnutrnay be ismed. The Department rnay also impose
Lundituris un the rssuumicr of a pnllit UT iIaTIMIlUlIal PUT111L In aCUHddTILr-Mfl_ rules adopLod bN' air, CuTiiun&,dun_ A pumit Ln tiansidunal pninit shall be ir-niwaaLdy
revoked inaccordance imthG-S- 130A-23(d) for failure, af the estabfisbinent to maintair a innitrurn gradt, of C_ A p=it or trarsiticnal pernit may offienxise be,
sal sperdel cur re%,,oke-dinacc,c,rdarcewith G-S- 130A-232 Prays action Lozal enNiromntntal health specialists shall issue a pe=t every time a diange, in pennit status is
indicated. Prepare an original and one copy for I.Citipnal to to deft rati ctxe oc suer or ttor. 2. Cop-y for time local healthdeRutm-,nt.D%&poMti0n: Please refer- to
RocardsRetenton and Ihspositial Sd2edule SB,.(Y., for it Ilistnct: Htalth DepazurentswUzIll is published by,tht North Carolina Di,,qsionofArcbives&HistofyF
Additionalfonnsma.ybe ord,-mdfro�m:EnYiromnentalKe-ain Se;:tiar., 1,632 'Mail
EHS 1341 (rovisoO OT02)
Ervironmental Health Section
Comment Addendum - Attachment
Location Address: JiLU SCIDERS
NEWTON
aou nty: C01"ba
_Mate� Sc
Zip: 28658
Wastewater System: (j) muntipanorr-unity C) On-Sitp ystern
Water Supply: @ MuniccipaMommunit/ C, On -Site Systems
Permiltec BRENTBULLARD
9XIM
CondiflonstRemarKs icontlnu@0):
tqon-'.orr,PIivtItems;
Date: M21122014
Status Gode:
C atego ry 4: