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Date (MM/DD/YY) _ <br />Permit Number <br />Permit Type f <br />Facility Name Address City Zip Code CT <br />1cc,6 <br />Permit/Registration Holder Name Permit Exp. Date Total lime Inspection Type <br />J1Ik' . — .1 <br />„�RAGfiCfIC!RtlRwv- <br />TlS#i�MEf,.::.., x r....„. ,,,, .. <br />35. Plan Review <br />0 <br />36 Permits Obtained & Available * <br />❑ <br />37. Impoundment <br />❑ <br />38. Hearing Scheduled <br />0 <br />39. Closure* <br />0 <br />„�RAGfiCfIC!RtlRwv- <br />TlS#i�MEf,.::.., x r....„. ,,,, .. <br />�f <br />WE ig <br />FRS .TI�i p TIS �,.2-0 <br />, <br />,W "t wig a A a L a J <br />mawwrli =714 <br />HAW f <br />Received by (Print): Received by (Signature): Phone: <br />Specialist (Print): Specialist (Signature): Phone: <br />This report is an Official Notice of Violation. Corrections must be completed in the time specified. <br />A reinspection fee may be charged if violations noted on this report are not corrected by the reinspection date. Reinspection Date (on or about) <br />Paqe of <br />, <br />,W "t wig a A a L a J <br />mawwrli =714 <br />HAW f <br />111. 111 ” '► <br />IN <br />rIt'1//../ I►.: r, iniT <br />�1 <br />lr s <br />lil ,` r <br />rr� <br />NOWilly <br />� - <br />y <br />♦ ,` <br />Received by (Print): Received by (Signature): Phone: <br />Specialist (Print): Specialist (Signature): Phone: <br />This report is an Official Notice of Violation. Corrections must be completed in the time specified. <br />A reinspection fee may be charged if violations noted on this report are not corrected by the reinspection date. Reinspection Date (on or about) <br />Paqe of <br />