HomeMy WebLinkAboutUPI REPORTOwner/Operator: � h l,! H A- IM -UN1 ` j
Facility: L UI ;16 ;�-
Address : -,719—t r. /v (b
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Notice Of Violatiorr:'Class ll and /or Class I Violations were found during this inspection as
noted in the following ry of Violations.
VIOLATION,
The'violations indicated in this inspection report must be: corrected within 30 days, unless
DATE.FOR
CORRECTION.
otherwise noted.
Formal enforcement will be initiated for all Class I Violations, and for any `Class 11 violations not
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.corrected within the required timeframe. This report does not represent that there are. no other
violations at this facility. A re- inspection may occur to determine compliance status.
SUMMARY OF VIOLATIONS
Inspectors
Signature:
Item
VIOLATION,
REQUIREMENT FOR CORRECTION
OF VIOLATION
DATE.FOR
CORRECTION.
Date:
C) /X/ ,� .l
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Inspectors
Signature:
Received by:.
Phone:
Print Name:
Date:
Date:
KPS #8447
White — Business Copy Yellow Business Copy to be sent in after Return -to- Compliance Pink — Prevention Services Copy