HomeMy WebLinkAboutMinor Violation Pg. 3 10-10-16Owner /Operator: , < S��� (C lz� rC V
Address z CR
There were.NO'violationsiobserved during this ; inspection
' .Notice to Comp/yno Violations were found :during th :is inspection as noted in the following
Summary of Violations.
The, violations indicated in his inspection report must be' .corrected within 30 days; unless
.otherwise noted.
Formal enforcement may be initiated,for�any violations noted, and for those not corrected "in a
timely. manner.
This report does not represent that there are'.no other violations at this facility. A
re- inspection may" occur to determine compliance status.
SUMMAKY OF VIULATIUNS
0M.: REQUIREM ENT :FOR CORRECTION OF DATE •FOR
VIOLATION
# VIOLATION CORRECTION .
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Ins ectors
P - Received by
Signature; %,
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Phone: r Print Name. s` , ' �. 1 � ', �� d�. r �"
Date: g, R
Date:
CERTIFICATION OF ,RETURN TO COMPLIANCE
I. certify that. the violations: noted above on this Notice to Comply Summary o Viola'tio'ns have been..
.corrected:: I have'perso-nally examined any documentation attached to the certification to establish that
the violations: have, been corrected-:
Signature:
Title
Print Name:
Date:
KPS #8446
White - Business Copy Yellow Business Copy to be sent in'after Return- to- Gompilance PinK :— Prevention Services copy,