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Bureau of LP Gas inspection <br /> } 4 'r. <br /> `� CHARLES H. BRONSON, COMMISSIONER OF AGRICULTURE 3125 Conner Blvd., Suite N <br /> DEPARTMENT OF AGRICULTURE & CONSUMER SERVICES Attention: • FL 32399 Field Adminitra tra tor <br /> + .'= BUREAU OF LP GAS INSPECTION <br /> Attention: <br /> Phone: 850021- 8001 <br /> State of Honda FACILITY INSPECTION REPORT Fax: 8504921 - 8079 <br /> `Inspector ID: 33 Iltnspection Type: S'' l fracility Type:62 IICounty Code: g j JTotal Storage: /0 Q 0 I <br /> BUSINESS NAME: 21/ /n �LI f toto %y7 ST } ATUS STATUS DATE: i - __ I _ LICENSE #: <br /> PHYSICAL LOCATION: 4 D 0. a A� C /QIV Q .2 / » /J'll //1 .1BUSINEs& 1oNE: ( _ ) -- FAX: L_ -- <br /> OWNERSHIP CHANGE? NE <br /> GE? YES NO BUSSS OWNERSHIP VERIFIED BY: x <br /> SUPPLIER NAME: A 2 l / - s SUPPLIER LICENSE #: 0 D�,,,2 <br /> SUPPLIER LOCATION: L I ' a? / ' L I b rxrn71,0 itt/wk PAZ INSURANCE EXPIRATION DATE: <br /> Qualifier Name - . to Tyype&CIass Test Date Expiration Date <br /> OWNED BY: 0 SUPPLIER 0 LICENSE/OPERATOR 0 OTHER CONTAINER SIZE (WATER CAPACITY): <br /> r'ONTALNER MFG. & SERIAL NUMBER: pc) Aviv CD / D O $', L D J <br /> An inspection of the LP gas facility listed above was conducted on this date. The following code deficiencies were noted and must be <br /> corrected within the time frames) specified. A reinspection may be conducted at the end of the designated time period to verify <br /> correction. Any deficiencies not corrected at the time of reinspection will be subject to administrable fines pursuant to Chapter 527, <br /> Flonda Statutes. NOTE: REQUESTS FOR TIME EXTENSIONS MUST BE SUBMITTED TO THE ADDRESS IN THE UPPER RIGHT <br /> HAND CORNER OF THIS FORM IN WRITING STATING THE REASON(S) AND LENGTH OF THE REQUESTED EXTENSION. Such <br /> requests are subject to approval of the Bureau of LP Gas Inspection. <br /> CORRECT PREVIOUS <br /> REFERENCE DESCRIPTION OF CONDITION BY' f CFfE? <br /> t � <br /> tit*, ! <br /> —r { 16? si E1f+2 5' ,{ f Lp <br /> It? I + <br /> l i <br /> - <br /> All conditions identified as "past due" must be corrected immediately before further use or operation of the equipment. An <br /> administrative fine may be imposed for any violation cited. REMOVAL OF A RED TAG LS PROHIBITED BY LAW unless <br /> authorized by the Bureau of LP Gas Inspection. <br /> O <br /> DATE OF THIS REPORT: 8 71 a LP GAS INSPE • OR NAME: FRED HOOVER <br /> I ACKNOWLEDGE RECEIPT OF THIS REPORT (SIGNATURE): 1 t t , ,' , .. , <br /> PRINTED NAME /TITLE OF SIGNEE: x ' ' �� - �' ) <br /> INSPECTOR TIME OF ARRIVAL: / I I SS` ATTACHMENTS: DATE: ?4 7 kO <br /> t r.1 CS -03522 <br /> COI Distribution: Original - Tallahassee; Gold - Licensee; Pink b Yellow - Field inspector <br />