Clark County Combined Health District
School Environmental Inspection Report

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

School Date of Inspection
1374mm 63/15 /i'i
Address Type of Inspection
my?; I 5 5 ion wars .3 4 Routine Complaint Consultation Follow-up
Zip School Classi?cation
Citys Pn?wp?d?j r4450 5' Public Nonpublic
County Phone Type of School (Check all that apply)
Irv-? 5'0f a Preschool Intermediate
Fangs; Chief Building Administrator High
. iementary Career Center
8 NW iddle Other
Grades of instruction Regular Hours of School Operation HVAC System (Check all that apply) HEATING COOLING
to I bit? {6 5?3 .. 3 2.1% Central Forced Air Systems 
Enrollment Classrooms Year Constructed Year(s) Renovated Rad'ato Electric Heating Units ni'a
School District J, 0 kw Geomennai
YT l- S0 5 Other
W. *1
Indicate areas of de?ciency by marking a propriate box
Grounds Sr Building Exterior Science Classrooms Auditoriums Student Dining Custodial Closets
Playgrounds Visud Arts Classrooms LibraryI'Medla Center Mechanical Rooms
Solid Waste Disposal Areas lnduslrid Arts Classrooms Indoor Athletic Facilities Atlicsr?iilezzaninelerawis
Outdoor Athletic Facilities Stage 8: Set Design Areas Locker Rooms Wateerastewater Sys.
All School Indoor Environments Music Roomts) Training or Weight Lifting Rooms Healthcare Areas
Hallways ti. Stairweils Family Consumer Science Restrooms Admin AreastRuiastiProtocols
Observations and recommendations for change. if adverse condition exists Location
{Mr 
WI "u lb 30
Gum. we. on (riddingEdit N. whow-H?iwa, oil I ~14 lift;
0 
I
U, Web: basics 5&1, iv] on top at: at, him: H- IV

3 .rt 25'
inspected by Health Name of hool Statl Accompanying Inspector
a cw?;
Signature Date No. Phone
ol/lSJ'7 W090 ??7w370*56?0
Received by/ Date Title Phone
Mam or 

 

 

 

 

 

Clark County Combined Health District

Pgiofl'

School Environmental Inspection Report Addendum

 

School Sohool District

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(EA-MU Jerald [Ismail/?git?
Observations and recommendations for algae, if adverse condition exists Location
34W 7A
601; Mme 
Gum MW 25'
way. Is
7/7?
\Lmolp: 7"
031W I

Nam 04m, A 
by Way ?Wm 
Shrew/??3 437:5 I1 #:134sz 4% 
Rece?bermb Date Title 0.4sz 4mm Phone

 

 

 

Clark County Comblnod Health District
School Environmental Inspection Report

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

School 
?Keillor Madamx/ Tl/Zfl/ lis
:mao 1? 0 d. m6 Complaint Emulation Fm
Zip School 
m5 Pf?lnfa?rl 45305 Nomubb
My Phone Typeoismool {Glackall?latappm
?39'5054l20 Preschool with
P?ndpalorChiafBullohg ?mm? mm Cam

Glades of Regular Haul: at School Opem?on lec System (crack all lhat apply) HEW 


Enmlment CW Yaanonstmoled Yearlamalmalad ??lmmr ?a
mm 1m 

Spring?eld Other

 

 

 

 

Observations and mmenda?om for change, if adverse condition ulsts Location
Nlce locum; 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Bola. are ?"?Ecwp mm ?g?ff's?wlwm
l. . 'lj?gl/l? Two/444040 :93? 3406M
Paul Tomoc l/Zol/I?S Qua-locl'imn Was-4:20

 

 

Clark County Combined Health District

School Environmental

Inspection Report

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

School Danni Inspection
wamm Keri? llama 9/5/ 201'?
Mm I: 
lam ?lms: l2?J? Comm emanation Folow-ip
City Zip 
(+5595 Nmpublh
Counti Phom Typoof Sol-tool (Ohmic all 
$31 - mwrten I ma
- - Hon
Prlnohal or Chief Admhis?ator anaer Center

Glades of instruol'nn Regularl-lours of School Operetta WAG 8% (Check al HEATING COOLING
Contra Forced Air Systems
Enrollment Classroom YearConstrucind YearisJRmou-aled ?mm
l?
II: No
School memo 
Syn-?341: i ?3'f 0+3 Jokools 0mm

 

 

indicate am: of


  

 

Observation and mommndatlons for change. if adverse condition wrists

Location

 

Observed at mim- *Couni-aln lowered a4 qu Same sank PM 

 

cor Aum?tia'inot) ?pail? /chemirod

Sc Paar 

 

0' ?l 31' 
+0 goldenis-

.553le

 

 

 

 

 

 

 

 

 

 

 

Health Dismal

 

Nmnoofsmool Inspector

 

In
?mahm Equaers exam 9mm Tcw?ioc[mg 9/3/11? Job-404'? 
Rooelvedby This Phone

Mm Taylor ave/m Head Cusiodian 937-505-4r20

 

 

Clark County Combined Health District
School Environmental Inspection Report

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

School Date of Inspection
Kenrvocd Elementary 3r'23lIB
Address Type of Inspection
1421 Nagley Street Routine Complaint Consultation Follow-up
City Zip Scirool Classi?cation
Spring?eld 45505 Public Nonpublic
County Phone Type of School (Check all that apply)
Clark SST-5054220 Preschool Intermediate
. . . . . . . Kindergarten High
3"?de Elementary Career Center
Middle Other
Grades of Instruction Regular Hours of School Operation HVAC System (Check all that apply) HEATING COOLING
8:30-3:02 Central Forced Air Systems 
Enrollment Classrooms Year Constructed Year(s) Renovated Unrt Ventilators 
4-46 28 2003 SteamrI-Iot Water Radiators El nla
Electric Heating Units nr'a
District Geomem?m [f
Spring?eld City Schools Other El

 

 

 

Indicate areas of

 

Custodial

Solid

Outdoor Athletic
All Environments

 

 

 

 

 

Observations and recommendations for change. if adverse condition exists Location
Observed there to be no safety data sheets (803) in the art room for paints, glues, etc. It is recommended that SDS for items in the art room be provided. Art Room
Observed the mulch to be not at the recommended depth on the playgrounds, especially under the swings. It is recommended that the mulch be regraded Playgrounds

so it is at the recommended depth to reduce the risk of injury in the event of a fall.

Observed several chemicals in each classroom. such as hand sanitizer. cleaning wipes, white board spray, etc It is recommended that SDS be provided Classrooms

for all chemicals in each classroom.

 

Observed several handwashing sinks to not have handvrashing signs posted. It is recommended that all sinks used for handrvashing have handvrashing

K-2 girls restroom, front

 

 

 

 

reminder signs posted. hall boys restroom.
classrooms

Observed soap dispensers to be missing from the restrooms. It is recommended that the soap dispensers be replaced to ensure proper handwashing. boys restroom.

front hall girls restroom
Observed the vvater fountain crest to be very high. It is recommended that the water be adjusted. so it crests 1-2 inches above the mouth guard. Room 8-9
Observed the panel in the mechanical room to not be easily accessible, due to multiple carts of items being stored in front of it It is recommended that the Room 303 -
items be moved so the panel is easily accessible. mechanical room
Observed the water pressure to the wash sta?cn in the art room to be too weak to effectively flush the eyes. It is recommended that the wash Art Room

station be adjusted so there is adequate wamr pressure.

 

 

 

 

 

 

 

 

 

 

 

Inspected by Health District Name of School Staff Accompanying Inspector
Elizabeth M. DeWitt Clark County Combined Health District Gary Cardosi

Signature Date RSISIT No. Phone
per/,2; a/zma 369? 937-390-5600
Received by Date Title Phone

Emailed to principal 3r'23r?18

 

 

 

 

Clark County Combined Health District

School Environmental Inspection Report

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

School Date of Inspection
revved weighs seesaw. in in
Address Type of Inspection
any?! l, outine Complaint Consultation Follow-up
Zip School Classi?cation
m??wumt KPublic Nonpublic
County Phone Type of School (Check all that apply)
(f3? 5195' 2:26: Preschool Intermediate
. . . . . . . 7L Kindergarten High
Principal or Chief Burlding Administrator
Hum/t )LElementary Career Center
Hilario In 0' Widdle Other
Grades of Instrudlio Regular Hours of School Operation HVAC System (Check all that apply) HEATING COOLING
.. l9? Central Forced Air Systems K-
Enrollment Classrooms Year Constructed Yearls) Renovated 3323:3113; Rad' to 
re re a
14-1 1' 7'91 WD3 Electric Heating Units ni'a
District Geothermal
fpnva? blot 0' 4?3 SUI-row 1 5 Other
Indicate areas of de?ciency by marking a proprlate box
Grounds Building Exterior Science Classrooms Auditoriums Student Dining Custodial Closets
Playgrounds Visual Arts Classrooms LibrarylMedia Center Mechanical Rooms
Solid Waste Disposal Areas Industrial Arts Classrooms Indoor Athletic Facilities 
Outdoor Athletic Facilities Stage 8: Set Design Areas Locker Rooms Wateri'Wastewater Sys.
All School Indoor Environments Music Roomls} Training or Weight Li?ing Rooms Healthcare Areas
Hallways 8r Stainvells Family 8r Consumer Science Restrooms Admin Areaisules&Protocols
Observations and recommendations for change, if adverse condition exists Location
(papa-4r dirt omit-W owl? '0
I I 
Sewn/u hf
414? (o
9.4K
7/ to

Wis ml k?
(.1va or? 
Inspected Health District Name of col Staff A mpa ny ng Inspector
1M (A4 ML. 14?1"!
Signag? Date No. Phone
?i/H/rr H055 ?fs-r-zra??avo
Reoeivedby Date Title Phone
Cyan], [Cm?Wyr? Cots hydra?


 

 

 

 

 

Clark County Combined Health District
School Environmental Inspection Report Addendum



 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

School School District Date Inspection
iamwwl nmLA-s mat-m], 5M Ema; my meals 7 {4/17
I 5
Observations and recommendations for change, if adverse condition exists Location
?L?l
Grim 7?

Inspected by Health District Name School Staff mpanying Inspector
IIM Whit/L COD 
Signature RSISIT No. Phone
it. Host 7.27 sec #5660
Received bf I Date Title Phone
Can-dog Gus}. aim-4

 

 

 

 

 

Clark County Combined Health District
School Environmental Inspection Report

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Sdlooi Dateoflmpeolion
Wi?ioruce. Mann Elemeniaf?l 1/ 2? ?5
M0011 ?i 30w 5* Comm Comm Follow-up
Zip mm 
WSW MAG: 6ch 46505 NW
Phone (Check all thatappbl)
3:me monsoon
or?hiof Bumm Aduinbtmor ?when
Kevin 3::ng
RogularHoulaof SclmiOperatim HVACSy-olom (ohookalmatapply) HEATING 
CentniForoedAlrms
Enldment Elm Year Guam Yams) Rmovalod ?'1!me .
Siam?-lolWaterRadlatom nia
EiaollicHoalingUnlb nie
Sohoothtid Manual
Sp?nq?eid Eli-'1 Other

 

 

amoef

 

 

Observetlons and recommendations for change, if advemo condition exists Location

.Wuswlm mow-5+5 nay-Ce

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Ins oted HealhDislrict NarmofSoimoIStafonoo Ins
Monika More 
3 la Dab RSISITML Phone
1/1 8 )5 454 r: 9?29-?a?5wo
by Dale Title le


 

 

 

 

Clark County Combined Health District
School Environmental Inspection Report

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

50"? Data of Impedion
Harm Wan Elamh-MM ?1/1911-1
Address 
Man ni? ?by; . Wire - Complaint CONNOR Followp
cur Sdrool cmmoauon 
Nmpubln
(intuit;r Phone Type (Check alihai apply)
. Olav?it: 505 qv?o Preschool lniermediah
Princ'pai or Chief Bung Administrator Klandemm Him
4? xEIenentary Caner Center
m? Sck?t an Kmart; Other
Reguiar 530i momma (Olmka??latapply) coouno
?7852 
Enrollment comma Year Wand Yeats) Renovated ?em
?Us" 239 Sham maternadm ?a
?i amnearmgUnio nra
Sdiool Dislriui Geoilm?
Sprm?'?i?, 6? *3 Mo}; Other

Indicate areas of boat

  

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Observations and for change, if adverse condition exists Location
Bud" Whom loos? {$qu and long; Jim" El}
Wis Hill-I
Siacwai 930i 1'7

tomb? - whom bookckdit "gnu/(w 
Li
as
l43- 93w, 5
momma Lo! hf": Health ??0in Nam?fz . 

sung?; R?nf?ogp 59 P923: 45% 5'60?

Rooe I Date Tribe Phone
RM. Noni-19W"? Mhdw'x

 

 

 

 

Polar}:

Clark Countyr Combined Health District
School Environmental Inspection Report Addendum

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Sdlool School 015m Dainof lnspec?on
W11, {pmM-?dd Jcho?'j /t7
. 1] 
OWEMW ?commonwealth for change, ifadveiee-oond?on Location 
I
"u no: a #1 Mr ?41,
3'5
m?b
lm?ed lih District ofSuhooiSta?Acoompan
tub, Wmie. 88 600 man?owglg inspector
Signet: Date RSJSIT No. Phon?a
(16.: {If/2451i?? Lb"io?b "fa-martin 
Received by] 9 Date I Title Phone
Ri?e Yuan Hamming, Ma?a .4


 

 

 

 

 

 

Clark County Combined Health District
School Environmental Inspection Report

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

School .. Daiaofhspec?on
Clark Earlu Learnmq Gamer f/Z? /l?6
Adriana 
1500 IeFFerSon Oomlaim Consu?alion a Follow-up
Zip 
Spn'nng Id 4550 (0 RPM: Nonpl?c
Gwniy Phone Typed (Mal?ntapply)
Clark. Wool? {$1.1m

Dabm new 5 0 am? 333??
RaguIarI-rwrsof SMOpera?nn HVAB System (aluminum) HEATING coouuc
. -
umwmnam
Emoilmem Clea-mm Year Muted Yams] Nata nfa
sum am ?a
Spring?eld 0H4 warm
Indians of

  

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


1'

Date Phone
-. 4047 9393906600
Dab Tile Fhona
Debra. Amur?o l/zwms pampm $37-$05v4mo

 

 

 

Clark County Combined Health District
School Environmental Inspection Report

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Sohooi Date of klspaofnn
Starla Earth Loam?? Lrua?r I [1
Address Type of Impawm
{sea in). daft-ts: ?a x. Rouline Canolalm Consultation Follow 
Oily Zip School Classi?cation
55.; KPubIb Nmpubrrc
Phone Type of School {Check all thalappIy}
bum/u..- 73'; Hr? XPresmtaol htarmediata
Bulding Administrator 32:23:?? :32er
.215 A?uursc were 
Glades of Instl'uctbn Regular Hours 0! School HVAC System (Check 3! that aptly] HEATNG GOUJNG
mm ?232:: @4319- 5c
Mums Yaar Constructed Yams] Renovahd Umt vm?
.3 1 .13 5 SW01 Water Radiators Illa
EleohtcHeatl'g Unlls nra
Sdmol District Gao?umal
Sprig-Fm C. faint: O?'lar
1 (r
Indicate of

  

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Observations and mommondations for change. If adverse condition exists Location
M.
pm. i

Po ?4 59m? UM glamour Ms domm 9'lnspeotj U1 Mk Health mace-H3! Name 33:51:30: mmiwgg Impedor
sumac; $7151? Rigrioqasg ??ag
memory or ?ate Title Phone
Homo-5o phi-tufts?!

 

 

 

 

 

Clark County Combined Health 
School Environmental Inspection Report

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

sonool 
Woods If I It
Address Typeoflnapec?on
?+31 w, John xRoullne Complain: Conwlha?on Faun-m
Olly Z'p Sdloolessi?m?on
455m, XPt?ic 
County Pnono TypeofSchool (mummy)
Clank? ?43 to Preschool Immediate
ism?" mom?
Hem Dorm-j moon Other
RenularHomsm? Sdml?aera?m WAD?stem (Check HEA11NG comma
l4 I 9" x.
Emll?nant Classroom 
LETS 3 Emu-loam Units nfa
DEW Gadll'lamul
Spmali?w' Gm Selma L: omer
. 
Indicate arm of

  

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Obwvations and recommendations for charge, If adverse condition mists Locatlon


?Ema 1M m: mt mnW'jMF rm
1?

iinn?rw Uh? 
am 2:
5m?- has hm hm? 
Cyndi. l?l?b
\n
30
Sgtuool '25
54?" m- 3:

[lo
I eased 0f 
asp db, mint/k, an Wm 
319 Data RSIsrrNo. Phone
1-3 mo In, dost 39o gm
Received Date Phone
f? M. ammo WM

 

 

 

 

Clark County Combined Health District
School Environmental Inspection Report Addendum

Pgiofl

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

sumo! SdloolDism 
96m? Glennaa?ttd 043, Jaw: 
Lam 
Wt? 
{gler L5
NM [3
1? Gym, Ir
?53: em 9
Spam-?3 Napk- 
i
mt. 

Sw? ?ash? 
bani 
'9 Wm ?44?51. 
WW bana' Tl?a Phone
{/4359de

 

 

 

 

 

 

Clark County Combined Health District
School Environmental Inspection Report

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

School Date of Inspection
"Ptrr'm Woods Eiwlmt-?rq [Li 
Address 4 Type of Inspection
0 HA .5 )CRoutine Complaint Consultation Follow-up
City Zip Sohool Classi?cation
.3 550 to public Nonpublic
County Phone Type of School (Check all that apply)
(pterib 5o 43! ?0 Preschool intermediate
. . . . . . . Kindergarten High
Pnnapai or Chief Elementary Career Center
?tter Dorsal/I Middle Other
Grades of Instruction .. Regular Hours of School Ope 'on HVAC System (Check all that apply) HEATING COOLING
\g bw L, Central Forced Air Systems )1 
Enrollment Classroon'ls Year Constructed Yearis) Renovated RadElectn'c Heating Units nla
3mm? Other
I 
Indicate areas of de?ciency by marking a proprlate box
Grounds Building Exterior Science Classrooms Auditoriums Student Dining Custodial Closets
Playgrounds Visual Arts Classrooms LibrarylMedia Center Mechanical Rooms
Solid Waste Disposd Areas Industrial Arts Classrooms Indoor Athletic Facilities AtliestMezzaninelerawis
Outdoor Athletic Facilities Stage 8. Set Design Areas Locker Rooms Sys.
All School Indoor Environments Music Roomls) Training or Weight L'r?l'ng Rooms Healthcare Areas
Hallways Stailvrells Family 8. Consumer Science Restrooms Admin AreaisulesaProtocols
Observations and recommendations for change, if adverse condition exists Location
lam Woman Girls Wow Riv
?Bogs Post/worm 'lorr?r- 
('4le ii?
WOWW RM 310 
Ins by Health District Name ofilchool SEE-pmmpanying Inspector
ilm Lu] koL W5 on (.er a
Sign Date No. Phone 
on ?7/24 lb I-ioa?ie error-59W
Received by 1 Date Title Phone
0w? Crow?mu Ousted. em

 

 

 

 

 

Clark County Combined Health District

P9 

School Environmental Inspection Report Addendum

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

School School District Date of Inspection
Qoww? Woo-m 5?9 ?Wade/I (my Jaw's ?ilu in

Observations end recommendations for change, if adverse condition exists - Location
W16 Mimi?? 941'
WALK 3 
ll
?0 513
I
\Mormmw mom 
7-H

Baum WM 1274
Burr) PA 
3M Tm z:

I


9.an Wit mm 1
Inspe?eliiz I Health Bigot Name ?210.31?? mg?l?n?speotor
Sign Date RSISIT No. Phone
q/zz Lb - an 5 937?? 39? be
Received by I Date Title Phone
5 09W Cached?: 

 

 

 

Clark County Combined Health District

School Environmental Inspection Report

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

School Daeonmpawon .
30??)er Schod 2/2 /lg
Mm mammal: .
Mr! 5 Ha Rue, 91m a Complaint Consuh?a?on DFolIaw-up
Zip 5mm
So?ncbaeld 45309 um 1] ?am
PM We! ?aalappm
33W
Ammo: 
M6. Wo+min5 233?]? 1%me
Rogularl-{ousol Schooi (Check amtappm HEATING COOLING
:1
mm
Enrolment Classroom Year Dominated Vanda) Rmovahd Water Mb]! 
Ebelrlc?oat?ng?nk [1 Na
scmm. time 
Svrmo??eld om 

 

 

 

of

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

- . W?h? -. a A *1 
Ante Rim}? 
3:59;; ?gm Eq?gers wok ?g'm
of My. 212/164 @4047 
Raceway Date True . Phone
m. "mm a 2/1/1?6 cue-*mmom 937-505 43%

 

 

 

Clark County Combined Health District
School Environmental Inspection Report

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Sdiool MB of .
MW MtMib sdnvul ?$114?
Address Typedl'napedion'
5? row: on a. ?ver )diou?ne Complaint Consultation Fulani-up
City Zip Sohodi Chasm
5P rmkgu?j 455i; 5 ?x Public Nonpublic
Cuunly Phone Type of Smool 
(Adult 931~595 ,ofswa Preschool {Immediate
Principal or Chief Balding am 33:? cm
Rainbow Haws Other
Rogulari-loumof SchoolOpera?on Hwic sodium [Clacka?lhai apply) HEATING cooune
1 .1 Q. 451:? 1?13. GonnaIForoodAirSyaiam >5
Enroumoni Classroom Year Consumed Year(s) Renovated gm mm 
?50 W5, Units nia
aohooi mom Geolliorrnal
I ?u 

 

are-dot

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Observations and recommendations for change. if adverse condition exists Location
Cohan i" [lily 4
5 53mm 
Show?? five?? 5
7571; '1
33?? gr'w Sumo. Minam- ?i?v
13h. l0
Chow 0+ Uhgm?y 25]
25
TIM If?? howimmhw owi- 00.41;, 14
(414? 390} he? 2. 
Egaxk- who . mp
$33? Mg 1+me Nam??ydm Inspector
7:27:44? ?3 send
addendum 1* nae Tide Phone
?ab-04' Cain/shah" 

 

 

 

 

P9 7'
Clark County Combined Health District

School Environmental Inspection Report Addendum.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

School 
Silvio?? Lick-N" Saginaw-Full) W13 
emulation: and recommendations. for chime, If adverse cmd?lon mists . mention
74*
Tdknolram Li?s! Ll

1% Mal ghori'admw H)
1% ?5

IL
is

2%
InspizT-id? I ?mle-Pb Ram? 
Signs .. No. Phone'
am ml .. 405; mm -m
Reuelml'hy Data Tltle Phone

 

 

 

 

 

Clark County Combined Health District
School Environmental Inspection Report

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Data at Inspeollon
I I ?5 I 5
Address Type of lmpecllon
{m [Whom months Consultation FoIanp
City Zip School Shuf?e?lion
Ll ?59 5' Public Nmpubllo
County Phone Type of School (Check i that apply)
CloutBulldog "In" new
.TYusom gammaschoo HVA 
Grades ?1 agu Systegma??mapply) Hague 60%le
Enrollment Classrooms Yearoommd Yealia) Homo ??er mm 
3% l? ??05 Electric Heaths um nla
summon oeomm
91? cf an ,3 Other
Indium of

  

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Obsamtions and recommendations for ohms. if adverse condition exists Location
raw, Mi 
ka FIG
903m 
[3
- MW Rama-m on 5th? lrw. in lull-tr famsur?b - 
bib-ma, I m?
1W morn- M3
30mm Lab I
W?s? 33? ill
Wes UL .29..
mg: ying Inspec?ir
5m Muir ?my? igloo
?W?F?va? 

 

 

Clark County Combined Health District
School Environmenial Inspection Report Addendum

Pgiofl

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

smoomm can I
MAW Svm??f Adm/5 aim 
I I Landon
L039 3 sm? 5km- u-f?f om. Srnk? rm Mmkr' 2?6
31ml? 2,4
mum's 9.9.. '11!
Wm?s 9-P- - toow [mm only tat-1mg Lao
Emma. UM 
L?b- 1'1
Wm. 7"
lot


:Eww Health 12% RSISITNI: Name 
(1: #95; 3'70 
my Dab Tide Phone
45%? 6145494!?

Clark County Combined Health District
School Environmental Inspection Report

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

School Date oflns
?4qu Misti/?b [cheat nlt?]
Address Type of Inspection
Hob C, up? v, )GRoutine Complaint Consultation Follow-up
City Zip School Classi?cation
Sim p, LI 5 505 )(Public Nonpublic
County Phone Type of School (Check all that apply)
:2 qty-y - {a 4130 Preschool Intermediate
. . . . . . Kindergarten High
Principal or Chief Burlding Administrator Elementary Career Center
?0 SDI ?01'5- FMiddle Other
Grades of In ction Regular Hours of School Operation HVAC System (Check all that apply) HEATING COOLING
:1 to 7:2 .. "t Cental Forced Air Systems 
Enrollment Classrooms Year Constructed Year(s) Renovated grima?mte Rad' to 
. a rs a
79w 1?9 Electric Heating Units ni'a
99?? Dim? Geothermal
Spnh??plbioi 01h fol-too IS Othet
Indicate areas of de?ciency by marking a propriate box
Grounds a Building Exterior Science Classrooms Auditoriums 8. Student Dining Custodial Closets
Playgrounds Visual Arts Classrooms Center Mechanical Rooms
Solid Waste Disposal Areas Industrial Arts Classrooms IX Indoor Athletic Facilities Atticsi'lvlezzaninesi'Crawls
Outdoor Athletic Facilities Stage Set Design Areas Locker Rooms Water?NastewateI Sys.
All School Indoor Environments Music Roomis} Training or Weight Lifting Rooms Healthcare Areas
Hallways it Stainvells Family Consumer Science Restrooms Admin 
Observations and recommendations for change. if adverse condition exists Location 5'
30938 RM
Q) P_?o
Ufa: t3" lIsL+ awn? 
I 
W519 
HW- 1?3
tnbmectf' Mt
Shel?? ?44if? if?
Inspecte by? Health District Name of School Staff Ins
im Wind? t?tD mm
Signatu Date No. Phone
[Ii-i It?! it: "Li-i066 ?thaw-v5??
Received by Date Title Phone
pinto ?in (Mahdi
I

 

 

Clark County Combined Health District

P9 

School Environmental Inspection Report Addendum

 

School

 

 

 

 

 

 

 

 

 

 

 

 

 

my Jami/3 Dam 5%

Observations and reconmendatlons for change; adverse conditien exists Location. "5 
Scum (AV luau. .Caww'} 9? {17 Lotta. 1?6
TIL 50% I 1;


9?35 hum p10
Sow/w La'ia 7/1
14
1?6
Tum: f?w {Ln-o
1% is

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Ins 1b)!

 

 

 

 

 

 

Heal1h Dis Name of School 8 Accompanyi Inspector
i 1' a o!
Signatu Da RSISIT No. Phorie
?1 lull? Ila" Linn?: Gin?geodetic
Received Ky D?te Ti?e Phone
Win 4% i?nlm 

 

 

 

Clark County Combined Health District
School Environmental Inspection Report

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

School Damm7padbn
Lincoln Bulef-m, .f (Lil?
Typefnspac?on
[6m ?bho? FM- Rom Gomphinl Consultation Fouowp
Ciy Zip 
span?hud .1550; )4th Nonpublic
co Phone odemi hackailihai
5:6 Hugo Paganini my Intarmed'aia
Pmolpal ?(:1than minimum gm?? 0H3: 
min WHEN )6 moose Other
Gauss ofm?uo?on RegularHans of sonoo: Operatlon mac 3mm (Check all that apply) HEATING 
L, 3 Oer?mlFomadAii-Bysiems 
Em'oimanl cm 1'3owle YearMRemvalad School District Gm?ml
0m
1 
Indicate of

  

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Observations and recommendations for changLil adverse condition exists Location
Wild/UL 25'
?7'}Ml can/44v 
?og/5 ?ow #13
(aids Km? Rn.?
5f?bl?l 33:1. 
Libra-2f- mg i
5M room. m;
111w
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19* am!? 
W. is
ELL Lyra/? RSISIT Nu. "m PEFAEW
'5 Ill? he l??qu?a lsrz?aa-?m
Received C)_q (I A ?1 I Data New)? ova? Phone


 

 

 

 

 

P9 Df 
Clark County Combined Health District

School Environmental Inapec'tion Report Addendum

 

School

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

mammal:
Limb? Ulla-ll{low :24.

Ll? a 
3m? - 
"Find-:5 PM. ?91
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if

 

 

 



Received

Da Phone
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- AMT h?lc Mali/?W 

 

 

 

 

 

 

 

Clark County Combined Health District
School Environmental Inspection Report

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

School Date of ins
[Anya in 
Address Type of Inspection
i 5?00 Bim', outine Complaint Consultation Follow-up
City Zip School Cias Iication
Lf $30 5' Public Nonpublic
County Phone Type of School (Check all that apply)
Cta??" 31 595? Inge Preschool Intermediate
Principal or Chief Building Administrator 7? K'me'ga?e" Ce
ILL w] a )(EIementary reer nter
Middle Other
Grades of Instruction Regular Hours of School Operation HVAC System (Check all that apply) HEATING COOLING
io (3:30 3:02? 3L )6
Enrollment Classrooms Year Constructed Year(s) Renovated Unit Ventilators 
Li 5 5 1? 10 SteamIHot Water Radiators nia
Li 3 Electric Heating Units nl'a
School District Geothermal
[all gaiwni'jo Other

Indicate areas of de?ciency by marking a propriate box
Grounds Building Exterior Science Classrooms Auditoriums Student Dining Custodial Closets
PMrounds Visual Arts Classrooms Libraryiilltedia Center Mechanical Rooms
Solid Waste Disposal Areas Industrial Arls Classrooms Indoor Athletic Facilities AtticsiMezzaninesl'Crawls
Outdoor Athletic Facilities Stage it Set Design Areas Locker Rooms WaterANastewater Sys.
All School Indoor Environments Music RoomIs} Training or Weight Lilling Rooms I-ledthcare Areas
Hallways Stairwells Family Consumer Science Restrooms Admin AreasiRuIeasiProtocols
Observations and recommendations for change. if adverse condition exists Location
Ianchn spun-calls} rem? - paper/r wit-W 
I
Liiow?r?? 
Kieth/ma I
I -
i 
15m: 

7101
5,ail? til?emir- on Wanda? 5!
. 
9 

in ant?Mb? 

 

 

 

In?s'pected by:j Health m)




 

1

[Jr liens

Name of Szhool taff Accompanying Inspector

 

 

 

Signature No. Phone

?fbii?l 
Received by! Date Title Phone

(NH/vs 

 

 

 

 

 

Pg _1 of J:
Clark County Combined Health District

School Environmental Inspection Report Addendum

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

School School District Date of inspection
3 uncut? Elem??- Start-?Mold 7/9/17
. . - . Locatlon
{Aid-one
0 Him 
Inspected Health District Name Inspector
Jim MM cue-b o- was UHF-boo?
ll

 

 

 

Signamre - No. Phone
Q?/m Nubia? 

 

 

 

 

Received by? in Date Title Phone
imp mile 641 

 

 

Clark County Combined Health District

School Environmental Inspection Report

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

School Deieof Imeellon
Snowhl Elainmiary 12112117
Address Typsof Impeclion
531 Herding Road Routine Conplalnl a Cmeulation Polar-up
City Zip School Clml?cation
Sp?m?ald OH Public [3 Nmpubiic
Conner Phone Typeofsmour (Cheer all Manny)
Clark 937390-5000 Presmool [1 Intermediate
Bulding Administrator gmleuegm: Sagan?
Jenl'ller PM
Mickie El (Jitter. 
Grades oflnelmclion Realm Horns of School Operation HVAC System (Chad: ell lira: apply) HEATING comes
lr?d 3130-30!" Central Forced?rlr Systems 

En 
gamma earConslruolod earls) Renewal; 
Electric Heady Unib We
send Gsolhom?ral
WW WSW Other [3
Indicate areas of box

  

 

Observations and recommendations tumult-adverse condition exists

 

Observed some rooms with loose mouth pieces to the weterfountain. To prevent possible spillage and fall

hazards these should be tightened down so all

water drains to sink.

 

Obmod room 19?s water fountain to notcrest over the moulhpiooe. To prevent illness it Is recommended thatthe waist In

the fountain crest at least 1" above ihe mouthpiece.

19

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Inmected by Health Dinner Name at sorool Sla?Accompanying Inmeoior

Sepheirie Johnson GurlJohnoon

Signature Dale No. Phone
SWIM 12:14:17 3637 037-390-5000 x245

Received by Dale Title Phone

DENIM-010

 

 

 

 

 

Clam countyr Combined Health District
School Environmental Inspection Report

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

  

Ind-Ito of

School Date oil peoii 
Wm Ems imam Elm-who. ?Twit?
Address I a Type of ?tmeolion
9 . ?Routine mm Con?ia?m Follow-up
City Zip Sdlool
SW 45503 cm 
canny Phone TypedSohooJ (m allthatapply)
595 ??53 EWI was?
Principal arCliaf Ming Aduhlsiraior Career Center
p.014, Smhso Diddle omer
Gredesof ?Won Regulaerlsof SoinoiOpela?on HVAC System (Check all mum HEATNG GDQING
K'b $00 am ?puppy- 
Eminent Classrooms magnum ?a
Li? 3" 1M Electric Heating nia
WW Gao?mmal
a? mm 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Observa?ons and recemmenda?om for ohang?advem condition outlets Location
mm 

are. {imm- 
i?trob - bony?! ?1

i ?it
21% aged? 
- 
MW 15'
GM ii.
we! no- #13

rams pal Health District Na dammsenm yirql?pic?for
d??h [?u/937 Jim-mu

Remly?dby I Date Title Phone

mm 9m 

 

 

Clark County Combined Health District

Pelof 3"

School Environmental Inspection Report Addendum

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

mam ParlL My?, W3. ?aim? at}; $7330;
Dmmtimgnd adverse mn?tinnaagids My?
mam W) 
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Ill?!
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74
Md ivau m. C?b?ilwl' 1?
mm, off/h and [pay-w wilt! Mali-?10535 gnaw ?are
WEL Em? ?balm? Pm

 

 

 

 

 

 

Clark County Combined Health District

School Environmental Inspection Report

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Salim! Dal?!r Inspection
56?? ?fl/l5" In
I ?1 Typeof [man
.10 I 9- )(Romino Complaint Cmsullalion Fallen-up
City no mm
SWW ?15593 )(Pubiic 
Goun? Phone Type ofScheol {Checks matapply)
Principal orcnioiamoim mu 
1?6ka sou Snow?? 
Grade: of Instruction Regular Home of smuol Opeia?on HVAC System (Check all that apply) HEATING COOLING
4' .. it. 19"; .. loga- cmroroodnirayom 
Enrollment Classroom YearConoiruoton Vanna} Remind 
nia
I1 50 5 Ebomo?ooiho Units nia
School Disillci Mm]
om

Springhio? Cth?J Schoois

 

 

Indicate ems

  

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Observations and recommendations for change. if adverse condition-alas Location

L959 
Vim-~3- ruL- Slrih 15 mt 
?hs 

WE
?gm? Ra?! 12mm - 5ii%
5W5

ENE


Efren

Em

LT by JIM Ha?z: Reisrriio. 
Jar/L j'lo?lgl ?bb

Use Title Phone
?rlim it?? (1(th 

 

 

Clark County Combined Health District
School Environmental Inspection Report Addendum

Paint}.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Selma] 
.JWMJ [-1qu sum! 4215., 5am 12/25, 17
Wang! 
Ems
WW: PAL 2w
wom? i 
?105
?243
?7.44;
?74?
M3
:W?m my HMW Ra?s?- NameofScihllo'?iia? TE Philly Inspector
1" 1
[11 la 34:: sew
Reneivedbf Date Title Phune
11M 1".th 

 

 

 

 

 

Clark County Combined Health District

School Environmental Inapection Report Addendum

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

School: out. of in?ation:
Roosevelt Middle School 1$?$qmj
mass: Type of Inspection
.721 E. Home Road $321333: Complaint Consultation
Cit 21 School Classification
?ng fie EEOB Public Nonpublic
cm Phone: Type of school (Check all that apply)
m05_ 4 37 0 Preschool Intermediate
Kindergarten High
Principal or Chief Building 1: Eg?aelltary Career Center
Administrator: cum:
Monte D. Erigham
Grades of System HEATING COOLING

7?3 a'm' p.111. Steml?ot Water Radiators
Enrollment Classrooms Year Yearts) El??iric Heating Units
450 30 Constructed Renovated Geothermal
2005 
School District: Other
Springfield City Schools
Observations. and recommendations for ch?go, if adverse condition exists location
Doors Locked. Thank you. Custodial
Closets
Provided facility the following resources:
Employee Health Policy
- Norovirus Clean Up Procedure
- EpiPen Information
Handwashing signage
Observed the weather stripping on some of the exit doors to Throughout
be missing/damaged. To reduce the risk of pests, please Facility
ensure to properly seal all points of potential entry of
insects and rodents.
Observed the seal on fixtures throughout the facility to be Throughout
damaged. To reduce the risks of damage to facility please Facility
ensure to properly seal all fixtures to the wall.
Observed Emergency Eyewash Stations to have a lack of water Rooms
pressure in all science classrooms. It is recommended that 3 23
emergency showers and eyewash stations should be operational,
unobstructed and located within ten seconds of all
workstations. Eyewash stations should have at least fifteen
minutes of continuous water flow with adequate pressure and
should be capable of flushing both eyes simultaneously.
Documentation that emergency showers and eyewash stations
have been tested should be available upon inspection.

 

 

 

Clark County Combined Health District

School Environmental Inspection Report Addendum

 

 

Observed damaged ceiling tiles throughout the facility. To
reduce the risks of contamination please ensure the
following: ceilings should be present, intact and sanitary
with no water damage, stains, suspected mold or chipping or
peeling paint. Water stains on a ceiling indicate a leak of
some sort (roof, restrooms, other classroom plumbing, etc.).
Rust stains may be an indication that condensation is
accumulating on pipes above the ceiling. The water source
should be identified and corrected in addition to repairing
the ceiling. Ceiling tiles that have become wet and/or have
mold on them should be thrown away and replaced with new
ceiling tiles.

Throughout
Facility

 

 

Observed lights that were not properly shielded/guarded. In
order to reduce the risk of injury, light bulbs should be
shielded, coated, or otherwise shatter-resistant;
guarding/shields should be present on fixtures designed to be
equipped with guards or shields or provided in areas where
potential impact hazards exist. Please provide proper light
shielding.?

Throughout
facility

 

 

Confirmed that the ?Non?acid restroom disinfectant/cleaner?
does not kill norovirus. Contacted facility's chemical
representative who suggested that the facility should acquire
the chemical solution which does kill norovirus.

 

 

 

 

Inspected by: Health District: Name of School Staff
Grant Warden Clark Accompanying Inspector:

 

 

Ken Tilford

 

 

- mud?u No.16? Phone:
Signatur WW 4126 937 390?5600 ext 235

Date: 12/13/2017

 

Received by: Delivered to school vial Mail Title Phone

Date: 12/13/2017

 

 

 

 

Clark County Combined Health District
School Environmental Inspection Report

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

School Date of Inspection
Simon Kenton Elementary 11t20l17
Address Type of Inspection
731 E. Home Rd Routine Complaint 1] Consultation Follow-up
City Zip School Classi?m?on
Spring?eld 45503 Public [3 Nonpublic
County Phone Type of School (Check all that apply)
Clark 937-505-4210 Preschool 1] Intermediate
. . . . . . . Kindergarten High
Chief Burlding Administrator Elementary t] Career Center
Middle Other
Grades of Instruction Regular Hours of School Operation HVAC System (Check all that apply) HEATING COOLING
8:30-3:02 Central Forced Air Systems 
Enrollment Classrooms Year Constructed Year(s) Renovated UM Ventilators .
500 24 2003 Steaml'l'lot Water Radiators nta
Electric Heathg Units nta
School District Geothermal
Spring?eld City Schools Other 

 

 

 

Indicate areas of

Solid

Outdoor Athletic Facilities

All School
a Stairwells

box
Science
Arts Classrooms
Industrial
8: Set

Music

Areas

8. Consumer Science

  

Mechanical Rooms

WaterMastewater

Admin

 

Observations .and recommendations for change. if adverse condition exists

Location

 

Observed there to be no safety data sheets (808) in the art room for paints, glues, etc Provide SDS for items in the art room.

ArtRoom

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Inspected by Health District Name of School Sta?Accompanying Inspector
Elizabeth M. DeWItt Clark County Combined Health District Jeannette Monison

Signature Date RSISIT No. Phone
57mm mm 77/20/77 93??660"
Received by Date Title Phone

Emailed to principal 1 1120??

 

 

 

 

 

Clark County Combined Health District
School Environmental Inspection Report

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

School Date of Inspection
Lagonda Elementary 11l?29i17
Address Type of Inspection
800 E. MoCreight Routine El Complaint Consultation Follow-up
City Zip School Classi?cation
Spring?eld 45503 Public Nonpublic
County Phone Type of School (Check all that apply)
Clark 937?505-4240 Preschool El Intermediate
. . . . . . . Kindergam High
Enhagaslgucmef Elementary Career Center
Middle Other
Grades of Instruction Regular Hours of School Operation HVAC System (Check all that apply) HEATING COOLING
K-6 8:30-3:02 Central Forced Air Systems 
Enrollment Classrooms Year Constructed Year(s) Renovated Unit Ventrlatnrs . 
375 20 2004 Steaml?l-Iot Water Radiators nta
Electric Heat'ng Units El nla
District Geothermal CI
Spring?eld City Schools Other 

 

 

 

Indicate areas of
Grounds a

Solld

Atlrletlc 

All School
8: Slaltwells

  

 

Observations and recommendations for-change, if adverse condition exists

Location

 

Observed trash receptacles without lids in the girl's restrooms. In order to reduce the risk of bloodbome pathogens, it is necessary that trash receptacles

in restrooms used by females be covered. It is recommended that lids be placed on trash receptacles in restrooms.

Restrooms

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Inspected by Health District Name of School Staff Accompanying Inspector
Elizabeth M. DeWrtl Clark County Combined Health District Cathie Scott, Principal

Signature Date No. Phone
?ights 7% :9ng 77/29/77 359? 9374mm
Received by Date Title Phone

Emailed to principal 11l29l?1?

 

 

 

 

 

Clark County Combined Health District
School Environmental Inspection Report

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

School Deleoiinspootion

12Mi17

Address Type of Inspection

tBODMalden Lane Roulhe i3 Canohint 001mm {3 Follow-m

on Zip School Classi?cation

OH Pubic Wile

County Phone Typecdeaool (ohoohoslholaopm

cal: 937-390-5600 :1 Preschool :1 minimalism

Princip? or anal Bulldog i woolen 3 

Cheryl Fomtauoh a mom? 99"?

Grades Regularl-loutsoi oohool Operation [Check all Mam HEATING 

h-o 8:30-3pm oomroroed 


I Ci olao 

got merit 20mm ear salts) Renovated Water nia
Eleollchoallng Units nia



Spring?eld oily Minds 

 

 

 

 

Observations and moomntenda?ons for the s. it adverse oondition meets

 

Observed some rooms with capots. Recommend discarding carpets as they hold dust and mites that could

cause ?ame ups to students' allergies and asthma.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

inspected by Health Dishiot Name of sweat Shionoompen?ng inspector

Stephmie Johnson Down Black

Signature Doe Phone
Staphalrwedoiwow 3337 937-390-5600 X248

Received by Date Title Phone

fembsughos?sosdohoom