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Notice Of Violation: Class 11 and/or _Class I }Violations were found during this inspection as
noted in he following Summary of Viola ions.
Inspectors
Signature:
The violations indicated in this inspection. report . Must be corrected within. 30 days, unless
otherwise noted. .
Print Name:
Formal enforcement will be initiated for all Class I Violations, and for any Class 11 violations not
Dater
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.
_Al IMMARY OF VIOLATIONS
KPS #8447
Whiter Business Copy Yellow — Business Copy to be sent in after Return -to- Compliance Pink — .Prevention Services Copy
Rece ived b`
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Inspectors
Signature:
Phone:. �n� F-:-
... 4 a''Y� y 1.. ..+i O
Print Name:
Date: -
Dater
KPS #8447
Whiter Business Copy Yellow — Business Copy to be sent in after Return -to- Compliance Pink — .Prevention Services Copy