1995_0001 (2).tif STATE OF NEBRASKA ® STATE FIRE MARSHAL
246 South 14"' Street
Lincoln, NE 68508-1804
ORDER FORM V-010106
ORDER NUMBER ............... —.- 041307-12
DATE OF INSPECTION ............. 3/30/2012
OWNER ................................. El Vallarta
OCCUPANT ............................ El Vallarta
ADDRESS .............................. 1995 Ridgoiew Road
CITY/TO WN .......................... Blair
COUNTY ................................ Washington
HOW OCCUPIED ..................... New Assembly- Liquor Referral; 75 occupancy
FEE CARD YES M No ❑ REVISIT DATE
The above facility provides reasonable safety to life in case of fire, and upon payment of all required
inspection fees will be APPROVED at that time.
If you have questions on this Order, contact the District B State Fire Marshal Office at 402.395.2164.
Or mail at: State Fire Marshal Office, District B Office , 438 West Market, Albion, NE , 68620-1241
All items must be corrected to comply with the laws of the State oj'Nebraska and with rides and regulations adopted by the
Nebraska State Fire Marshal as mandated by Sections 81-502 to 81- 541.01
It is the ditty of the owner or person in charge of the above - named facility or location to immediately take Measures to bring
the facility into compliance with state regulations.
ALL CORRECTIONS SHALL BE MADE AND
ALL ITEMS CORRECTED ON OR BEFORE:
Any damage proximately caused by a failure to remedy the above listed deficiencies shall be deemed to be the sole
responsibility of the owner or person in charge by virtue of this notification and order.
Witness my electronically typed name at Fremont, Nebraska, this day of April 13, 2012.
By: Alan Viox #8713 Phone Number: 402-720-4451
DEPUTY STATE FIRE MARSHAL
State Fire Marshal E-Form 10-2004 Page 1 of 1 Corrections Order