HomeMy WebLinkAbout2016 RTCOwner /Operator: E 1 AA 1 �- C
FaciIit
Address: 4-/ ,
Print Name:
There were NO violations observed during this inspection.
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Notice to Comply: Minor Violations were found during :this inspection as noted in the following
Summary of Violations.
The violations. indicated in this 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:
..`"" SUMMARY OF VIOLATIONS
Item REQUIREMENT FOR,CORRECTION OF DATE FOR
VIOLATION
# VIOLATION' CORRECTION
P. `sue
' ice:
IInspectors --
.Signature: �-
Received by:
Phone:,
Print Name:
Date: '
Date:
t'_1= ?TI1=I['_®T1ON ()F RFTHRN TO COMPLIANCE
certify that the violations. noted above on this Notice to Comply /Summary of Violations have been.
corrected'. I have personally examined any documentation attached to the certification to establish that
the violations have been corrected.
Signature:
Title:
Print Name:
Date:
KPS #8446
IA/k;+- r r%r%%i YaIInW RI mi11P_RC (-rinv to he SP_nt in after Return- to- CoiriDliance Pink — Prevention Services Copy