HomeMy WebLinkAboutBerliner Kindl Permit 730796 10 10 14.pl.pdfAddress 2:
H I C K 0 R Y N C a 8 6 G 1
City: State; ZIP:
B E R L I N E R K I N D L
Permittee
M anager or Person in charge
[:] [A ailing Address Same
B E R L I N E R K I N D L
14 ailing Name
I � I B R 0 A D W A Y
1A ailing ,Address I
1A 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 Numcer
1 8 C atawba
Email Address: CoMy #
5-5 - Municipat/Community 3-3 - Muni cipaUCommunity N/A 01
Water Supply Wastewater System Risk Category Territory # capacity:
0 7 9 6 * Enter last 4 dig�ts only 73 - Temporary Food T
Facility lD Old Facility ID: Operate a: Status Code
14 ap # Parcel ID #
1 0 1 1 0 0 1 4
Let Long, Date:
Push Cart or MFU [:]Pushcart E] M FU
Pushcarliklobiie Food Unit operating in conjunction with:Restaurant or Commissary ID;
s E]180
Transitional Permit Conditions: Permit Expires: F-190 daycomdays
pleted by�
Condition sIR em arks Nan Derr Herns
4000
Non -Compliant Remarks Cirk the chevkbox to add non -comp kaor rt marks
Estattishment Assigned T o�
kA 444t�,� 2031 -Levin, Paige
Jv4s signature-,
2031 -Levin, Paige 1 0 / 1 0 1 2 0 1 4
EHS0 Date:
Title
M anageriPerson in Charge
1 0 / 1 0 0 1 4
Date:
NG Department of Health and Human Services [j]Permit F-]TransitionalPermit
D iv ision of Pu bfic I I ealth
Environmentat Hoalth Soction Date: 10110a2,014
BERR
Name of Establishment: BERLINER K[NDL P erm ittee: LINEKIINDL
It HI HICKORY
211��
State - NC Zip: 28601 Managiar/Pior-son In Chargc-,
Milling Nam BESLINER KINDL Gounty Cadawba
Willing Address 121 BROADWAY
City, BLACKMOUNTAIN State:,NC 1111 28tatus, code: T
, —S
E m a I[ Add re ss: Establishment ID, 2018730796
---------------------------
Phone- — Fax" map, #� - - - - - - - - - - - - - ---Par lID -- - - - - - - - - - - - -
Emergency Phone Number Lat ................ . 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 FoM and Lodging Facilities, See perma requirtments in Rules. 'f his permit is not, transfers to and may be revoked for failure to
comply wth all requi-ements.
WastexeaterSysterns; Rkiuricovc�rnmunk, []on -site System Capacty:
category #: 91 E ff]
Water Supply: [flM uricipalIC)mmunity E]On-Sits Systern M IE
Fushc3rt'Noblle Food Unitope'ating in conjunvion with Restaurant Or COMM SSa'y Name an —lid —iU63E-eT — — — — — — — — — —
CcinditionvRernark&
E etablahrro nt assigned to: 2031-Levin, Paige
---------------------------------------------
$itionall ParM it Conditionii;
-his permit $hall expire 01 and isnot renpwaWe, Ml rian-comrinan, items listed herein and on altaChed, Gages (if
anali--ablP0 must ce cDrmeeteJwilhln ::1 go / [J180 days days. This astablishment mist close if all noncornoliant items anz not corrected had the
expiration da:e.
Rp,roNpri Py Tit v
M 3nageriPerson in Charge
n;;tp, 1011=014
Signed BY: _Z-4--- REHS#: 2031-Levin, Paige Date: 101110,12014
tj �A-D 1� i si tn " of Public , H ea,lth
Ges -onfinueoperfation vathout a permit or tmnsiaonzt pmaitissued, by the D� a r Purpw�e� Genevrih OA218(b��state,",% tablobenmt shall mmmemw or L - eep rmaen
-M,pe.,t.rtr.,,it,.n1 M.,t 4alibe issued lo the &,vner or q3efator of the establistrrrnt and shall not be, tratiffemble- Ifthtestablishmentist,�,a-,.td,thtpennttar
transitonalperrimt stead be, issued to the lest mid lallriot betrAnsfiralolt.1f he locator or an establishment changes, a nt%vpff= shall be, obtained for the
shall adopt rates est2blishingg the,
requirements that must be met before a transitional pennt may lot, issued, aced floe period for Mutt, atranstionalpe=tmaybeissued. the Dtpannennia°,also inipost
L�CqlditunsUll ffirrisRxMicrul'aparent ul tialladunal Uansidunal ptiTint Matt beirnixdiactty
t-e�cke,din,accordance in,idiG-S- 1fit? A-23(d" for failure of the esialoUshment to maintaira triinitrurn, grade of C_ A pennit or frarsiticnal a =it may o0renxise be
suTerdtdo,rrFokt.dinaccc,rdarce,NkithG-S- 130.4-23" Preparation : Lcrml mAronmmtalheahh specialists shaill issue permit every- time a change in pe=tatatusis
indicated. Prepare an oriprial and one cop77 for 1.0,ngqreal to to left with thezi�mef or cperztor. 2. Copy, for tie local
Records Retentai and Disposition Sditdule 8 B .6, for F.crantvDi strict Haalth De.par=.entsMn:h is pub.i died by the, North Cxolina avi sim ofArchives & Hi -qom
Additionaliforrus may be ord-red from: Fn�lronmntalHealth Sector, I,M".MaE Smice Center, Ral,-igk-.',,C27dg.9-1632, Q�ourier52-01-9al
EH3 1341 (reviseO 07112)
Ery iron m enta] Health Section