HomeMy WebLinkAboutVIOL. MINOR 3/25/2015Owner /Operator: V (,7
Facility* 9 -
Address: �-
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There were NO violations observed during this inspection.
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Notice to Comply. Manor Violations were found during Ythis inspectio n as noted in the following
CORRECTION
L 9 AJ FU €✓ti/
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
CERTIFICATION OF RETURN TO COMPLIANCE
I certify that the violations noted above on this- Notice to Comply /Summary of Violations have been
corrected. 1 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- Prevention Services Copy
Item
REQUIREMENT FOR CORRECTION OF
DATE FOR
VIOLATION
VIOLATION
CORRECTION
L 9 AJ FU €✓ti/
--r C c 'C e..
A ACC p-r'r 0 SsWv C 12 hell, Y
n.spectors
t ,
Received by,: ,
Signature:
�'�'zf, y ,:
Phone: -a.
Print Name:
Date: -
Date:
CERTIFICATION OF RETURN TO COMPLIANCE
I certify that the violations noted above on this- Notice to Comply /Summary of Violations have been
corrected. 1 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- Prevention Services Copy