HomeMy WebLinkAbout101 19th st violation 8-28-13Owner /Operator:
Facility: 2 <- 7o :�2
Address: �1� K? A1
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omply: spection as noted .in the following
Notice to C : Minor Violations were found during this in � - �
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Rece ve y: -
Signature:
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Summary of Violations.
The violations indicated in this inspection report must be corrected within' 30 days, unless
otherwise noted.
Date:,`
Formal enforcement may be initiated for any violations_ noted, and for those not corrected in a
timely manner: Thisreportdoes 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
3V /! 3
1 4, !.' L� 77,1,5. ,, d .� i
(..x'06 /'•?r 7' C 0,e 76-7 f r /irr fC / <i17 �t. 3t <3
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%` # r 55 '`� /,L,- l•,r%u * -1 -0`12, */ .��, 1 ""� ) /S �' r^ �'t.J � r�G' 7 2 � �'� �` '?l � C is � r AJO r't il�'fl��.� r. '�✓ f/ Hof /�1 i
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Inspectors
,
Date:-
CERTIFICATION OF RETUWTO 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- correctefd:-
Signature:
Title:
Print Name: ,.
Date: r .
KPS #8446
Inn_:a_ n... _:.___ n_.,... Vclln�ec.— Riicinocc -f`nnv fn hA CPY1t<'FFP_CnRPtlJr
_ n -to- Compliance . Fink Prevention Services Copy
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Rece ve y: -
Signature:
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Phone: T f ?
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Print Name:
Date:,`
,
Date:-
CERTIFICATION OF RETUWTO 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- correctefd:-
Signature:
Title:
Print Name: ,.
Date: r .
KPS #8446
Inn_:a_ n... _:.___ n_.,... Vclln�ec.— Riicinocc -f`nnv fn hA CPY1t<'FFP_CnRPtlJr
_ n -to- Compliance . Fink Prevention Services Copy