HomeMy WebLinkAbout NOV 2016Owner /O erator: Q L 1 k ....
Facility: :k. c JrZQAJ
Address: 1 s- r
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Notice Of Violation: Class Il and /or Class I Violations were found during this inspection as
noted in the following Summa of Violations.
Phone: - � � .
The violations indicated in tftis inspection report must be corrected within 30 days, unless
Date:
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otherwise noted.d w
Formal enforcement will be initiated for all Class I Violations, and for any Class 11 violations not
corrected within the required timeframe. 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 DATE FOR
# OF VIOLATION CORRECTION
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Inspectors
Signature: -
Received by:
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Print Name: 4, ti i (-t
Date:
Date:
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White — Business Copy Yellow — Business Copy to be sent in after Return -to- Compliance Pink — Prevention Services Copy