HomeMy WebLinkAbout NOV 2016Owner /Operator: : 9Ag_/3g_;4
Facility:: 5'7- A44 06 f
Address: .2_5—a,_j oSc. ,)E.z_c_
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There. were NO violations observed du,rin,g this inspection..
Notice to Co" ly: Mihor.Vicktions were found during this inspecfion as noted in fihe`following
Summary of Violations.
The violations indicated iin� this inspection ithin 30 days -re ort must'be corrected W unless:
p W
otherwise noted'.�.
Forma[ enforcement may be initiated for any violation's noted, and. fot those not corrected in.. a:.
timely manner. This report.does not represent that there are no other violations, at ,this facility.. A
re-in8pectionrnay occur to determine compliance status.
SUMMARY OF VIOLATIONS
Item REQUIREMENT FOR CORRECTION OF DATE FOR
VIOLATION
VIOLATION .CORRECTION.
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.Inspectors
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eceiVed b
Signature:
Phone: Pri. nt.
Date:_ Ll_ Date:
CERTIFICATION OF RETURN TO COMPLIANCE
KPS #8446
White — Business Conv Yellow — Business CODV. to be sent in after Return-to-Comliance Pink — Prevention Services Coin