HomeMy WebLinkAboutNOT. VIOLATION MINOR 4/1/2016Owner/Operator:
Facility: .� .�
REQUIREMENT FOR CORRECTION OF
VIOLATION
Address:; -;
❑
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
#
VIOLATION
REQUIREMENT FOR CORRECTION OF
VIOLATION
DATE FOR
CORRECTION
j.
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Inspectors �; �. —..
-� -
Signature:
Received by:`°
4
Phone:
5
Tprint Name:
Date:
Date:
CERTIFICATION • COW PLLANCE
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:
nra TR544b
White —Business Copy Yellow - Business Copy to be sent in after Return -to- Compliance Pink - Prevention Services Copy
Owner /Operator:
Faclit
Address----
❑
There were NO violations observed during this inspection.
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MR,
Notice to Comply., Minor Violations were found durin this inspection as noted in the follow ^
g p wing
[-
Summary of Violations.
The violations indicated- in this inspection report must be corrected within 30 days, uMess
r,
otherwise n®ted. r
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 (IF VIn1 ®TInN
Item
#
VIOLATION
REQUIREMENT FOR CORRECTION OF
VIOLATION.
DATE FOR
CORRECTION
.
W>• ✓, _'lM,.. 4..:. f t •k. ..Y ;r -' .,. T' ,f ,
(•~- 'Y''5.,
FInspectors"
ature., r .
Received by: , r
Phone:.
Print Name:
Date � '� r °�'
Date: ,
CERTIFICATION OF RETURN TO COMPLIANCE
I 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 -
White — Business Copy Yellow — Business Copy to be sent in after Return -to- Compliance. Pink — Prevantinn Rprvinpq (nnv
AW
FAMILY MTISTRY
2520 H St Suite B
Bakersfield, CA 93301
(661)324 -1200
Att: Liseth
March 22, 2016
This letter is regarding the Final Notice of Violation, we bought this practice in
December 2010. When we took over this practice the office was all digital x -rays. So in
this office there is no hazards material in this office. If you have any questions feel free
to call us at (661)324 -1200
Priscilla Munoz
Office Manger
2520 Yf Street, BakersfiegCA 93301 * 661- 324 -1200 * 661 - 324 -5858