HomeMy WebLinkAbout1416 golden state violation 3-26-14Owner, /Operator:
FaciIit : ` � ' a A -
Address:
Print Name:. .'.
There were NO violations observed during this inspection.
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p y tions were found during this inspection as noted in the following
Notice�to�Com IV1mo�r� Viola
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.
SI IMMARY OF VIOLATIONS
Inspectors
Signature:,.
Received by:
Phone
Print Name:. .'.
Date: : �.� /zo/`�°'
D' ate:
CERTIFICATION OF RETURN TO COMPLIANCE';1
I certify that the violations noted above on this Notice to Comply /Summary of Viohations .have b "een
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
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