NYC 9/11 Public Portal Document
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City of New York ENVIRONMENTAL HEALTH SERVICES Department of Health
INSPECTION REPORT — NOTICE OF VIOLATION , PG. of
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ITEM DESCRIPTION OF VIOLATIONS
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NOTICE: Department of Health employees must show Identification on request t: j44 (/
RECEIVED BY SIGNATURE & BADGE s "' { SUPERVISOR S SIGNATURE DATE
- PENALTY FOR FALSIFICATION: Falsification of any statement made herein is an offense punishable by a FINE of not
more than $500 or not more than 60 days imprisonment or both. — NYC ADMINISTRATIVE CODE, SEC. 1151-9.0.
148E (4194)
NYC-WTC 000104728
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