HomeMy WebLinkAbout1975 FRANKLIN ST W A r INVOICE DATE DUE DATE INVOICE# TOTAL DUE
09/19/2023 09/26/2023 2024-00000098 $200.00
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Customer#: 21926 Please Make Check Payable and Remit To:
City of Waterloo
ATTN: City Clerk/Accounts Receivable
RAY'S SUPERMARKET INC 715 Mulberry St
1975 FRANKLIN ST WATERLOO, IA 50703
WATERLOO, IA 50703
Amount Enclosed:
DETACH AND RETURN TOP PORTION WITH YOUR PAYMENT
KEEP THIS PORTION FOR YOUR RECORDS
COMMERCIAL INSPECTION - 1975 FRANKLIN ST- 8-17-23 FOR BILLING INQUIRY: (319)291-4323
LDescription ( Total Price
REINSPECTION 3 $200.00
CUSTOMER# BILLING DATE DUE DATE INVOICE# CHARGES
21926 09/19/2023 09/26/2023 2024-00000098 $200.00
Less Prepayment $0.00
Total Due -* $200.00
City of Waterloo
Failure to pay in full debts listed herein within ninety days of the due date will result in an additional twenty-five percent
late fee applied to any outstanding balance. The delinquent account will be forwarded to Municipal Collections of
America for further collection efforts. Debts shall also be subject to collection through the Iowa Department of
Administrative Services Offset Program if not paid in full within ninety days.
WATERLOO FIRE RESC
UE
C� �ptER��O
INSPECTION REPORT
RAY'S SUPER MARKET,1975 FRANKLIN ST,BLDG 1 i t `975 FRANKL/N ST,WATERLOO/A 50703
DETAILS
Inspection Date:08/17/2023 Inspection Type:Annual Inspection(1Yr) Inspection Number: 10677 ! Shift: N/A I Station: N/A
Unit: N/A ! Lead Inspector:JEFF SIEBEL i Other Inspectors: N/A
STATUS CODE DESCRIPTION
FAIL 606.3.3.3-Records. Records for inspections shall state the individual and company p y performing the
inspection,a description of the inspection and when the inspection took place.
Records for cleanings shall state the individual and company performing the cleaning
and when the cleaning took place.Such records shall be completed after each
inspection or cleaning and maintained.
Inspector:JEFF SIEBEL-Comments:provide current semi-annual kitchen hood
exhaust system cleaning and fire suppression inspection report with all
discrepancies corrected. Cleaning Now 248 days past due and fire suppression 23
days past due Contractor must upload online to the compliance engine.
Location: Not Provided
GENERAL NOTES
JEFF SIEBEL-08/21/2023 @ 09:45 re-inspection$200
REINSPECTION DATE
09/11/2023
CONTACT SIGNATURE
Yasmine Yasmeen J
Signed on:08/21/2023 @ 09:45 h ate, ( f,,,;
INSPECTOR SIGNATURE
JEFF SIEBEL
Signed on:08/21/2023 @ 09:45
Printed on 08/21/2023 @ 09:47
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QUESTIONS ABOUT YOUR INSPECTION?
_JEFF SIEBEL
Jeff.Siebel@Waterloo-ia.org
3192301224
Printed on 08/21/2023 @ 09:47
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