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Coil Cleaning Record Card - Connecticut

Coil Cleaning Record Card Form. This is a Connecticut form and can be used in Liquor Control Division Department Of Consumer Protection Statewide .
 Fillable pdf Last Modified 9/17/2009
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LIQUOR CONTROL DIVISION This record card is to be kept on permit premises one year from date of last entry, and be available for inspection. Sec. 30-6-A23(e) of the regulations. State of Connecticut Department of Consumer Protection 165 Capitol Avenue Hartford, CT 06106-1630 (860) 713-6210 Any material misrepresentation in the following information will be grounds for revocation of the permit. COIL CLEANING RECORD CARD Permit # Date Cleaned Permittee Name Method Used Street Address Number Cleaned Coils Rods Town or City Signature of Cleaner American LegalNet, Inc. Date Cleaned Method Used Number Cleaned Coils Rods Signature of Cleaner Date of Inspection Signature of Inspector Remarks American LegalNet, Inc.
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