01-389Council File # p ��'3 j'y
Green Sheet # � p O G 3.S
Presented By
Referred To
Committee: Date
RESOLVED, that the licensee, Peter Amundson, d/b/a Borgstrom Pharmacy (License ID
No. 16685), located at 990 Payne Avenue in Saint Paul is hereby ordered to pay a fine of
$200.00 for the violation of the sale of tobacco or tobacco products to a minor.
Said fine shall be paid to the Office of License, Inspections and Environmental Protection
within thirty (30) days of the adoption of this resolution by the Council and signature by the
Mayor.
This resolution and the acrion of the Council in this matter are based upon the facts
contained in the Notice of Violarion letter to the licensee and the Tobacco Compliance Check
Purchase Form. The facts were not contested by the licensee.
Requested by Department of:
Adopted by Council : Date � �, �j(' �-OC� \
Adoption Certified by Council Secretary
By: ItiltGCC�. � � so
Form Approved by City Atto
BY. ✓ /
Approved by Mayor for Submission to
Council
BY � o \ � _ _ '1� .-�
��� g � By :
Approved by Mayor: Date /� 6E�
sy:
6
RESOLUTION
CITY OF SAINT PAUL, NIINNESOTA
�A
coun��i
�
io, Zooi I GREEN.SHEET
o l -38q
No1uu�35
)er noscrom Ucf.��rowgro. Varrm.c�—
AG@aA BY (��
AEi1fiN
��OL � Ci n ent IOAWBIFdt ❑CIIYAiIOAEY fJ1YClH11[
�
� a�,�.� .�.,�
❑ r�v°rtfae�amn"p ❑
TOTAL � OF SIGNATURE PAGES (CLIP ALL LOCATIONS FOR SIGNATUR�
Reco�ending that the licensee,. Peter Amundson, dba Borgstrom Pharmacy, 990 Payne Avenue
pay a fine of $200.00 for the violation of the sale of tobacco or tobacco products to'a
minor.
PLANNING CAMMISSION
CIB COMMITTEE
CIVIL SERVICE COMMISSION
OFTRANSACTION
SOURCE
rms uie a��� eve.xa�d unae. a cardrad rarenis depaemenn
YES NO
Hm Mia pnawJfirm aver heen a WY �DbY��
rES rio
Does thie ce�� a� a s16N rat iarma�No�aseaseC DY anY arte�d cnv emdovee4
YE4 HO
b thic pe�aoNfxm a targeted �eiMol7
VES NO
ilein aP vecarrewe�s on aeoarate sf�ee.t end atlech to arcen si�eet .
cosrmEVO+uE auocterm lq�tctR ot�7
ACTIVITYNUMBER
YES NO
�
01-��`y
UNCONTESTED LICENSE MATTER
Licensee Name:
Address:
Council Hearing Date
Peter Amundson, d/b/a Borgstrom
Pharmacy
990 Payne Avenue
Wednesday, April 18, 2001
Violation: Sale of Cigarettes to a Minor
Minn. Stat. § 609.685
St. Paul Legislative Code § 324.07
Date of Violation:
Place:
Presumptive Penalty:
February 27, 2001
Licensed Premises
$200.00 Fine
Recommendation of Assistant City Attorney on behalf of client, Office
of License, Inspections and Environmental Protection:
$200.00 fine (first offense)
Attachments:
1. Proposed resolution
2. Notice of Violation
3. License Information Report
4. Tobacco Compliance Check Purchase Form
5. License information
CITY OF SAINT PAUL
Norm Co[eman, Mayor
Apri13, 2001
Peter Amundson
OFFICE OF THE CITY ATTORNEY
C/ayton M. Robinson, Jc, Ciry Attorney 0`„', �
Civil Division
400CiryHa11 Te(ephone:651266-87l0
ISWutKelloggBlvd. Facsimile:651198-5619
Snin! Paul, Minnesota 55102
NOTICE OF COUNCIL MEETING
Borgstrom Phannacy
990 Payne Avenue
Saint Paul, Minnesota 55101-3902
RE: Cigarette/Tobacco License held by Peter Amundson, d/b/a Borgstrom Pharmacy for the
premises located at 990 Payne Avenue in Saint Paul
License ID #:16685
Dear Mr. Amundson:
Please take notice that this matter has been set on the Consent Agenda for the Council meeting
scheduled far 3:30 p.m., Wednesday, April 18, 2001 in the City Council Chambers, Third
Floor, Saint Paul City Hall and Ramsey County Courthouse.
Enclosed aze copies of the proposed resolution and other documents which will be presented to
the City Council for their consideration. This is an uncontested matter in that the facts contained
in the Notice of Violation concerning the unlawful sale of cigazettes have not been disputed. The
recommendation of the license office will be for a$200.00 fine.
If you have any questions, please call me at 266-8710.
Very truly yours,
���� �����
�
Virginia D. Palmer
Assistant City Attorney
cc: Nancy Anderson, Assistant Council Secretary
� yb a —�fZ;'
�5��;:,_ . �. _�. ..
° �� � � E��ii
�:3 .#
Roger Curtis, Director, LIEP
Christine Rozek, LIEP
Paul Maruska, Community Organizer, Payne Phalen District 5 Planning Council, 1014
Payne Ave., St. Paul, MN 55101
OFFICL �r THE CITY ATTOR��IEY
C[ayton M. Robinsan, Jc, Ciry Anorney Q,�� Y4
CITY OF SAINT PAUL
Narm Coleman, Nf¢yor
Mazch 5, 2001
Peter Amundson
civit Division
400 City Hnl!
1 S West Ke11og; Blyd.
Saint Pauf, hlinnesotn 55/0?
NOTICE OF VIOLATION
Borgstrom Pharmacy
990 Payne Avenue
Saint Paul, Minnesota 55101-3902
Telepkone: 651166-8710
Facsinaile: 651298-5619
RE: Cigarette/Tobacco License held by Peter Amundson, d/b/a Borgstrom Pharmacy for the
premises located at 990 Payne Avenue in Saint Paul
License ID #:16685
Dear Mr. Amundson:
The Office of License Inspections and Environmental Protection has recommended
adverse action against the cigazette/tobacco license held by Peter Amundson, d/b/a Borgstrom
Phannacy for the premises located at 990 Payne Avenue in Saint Paul. The basis for the
recommendation is as follows:
On February 27, 2001, a tobacco compliance checic was
conducted at Borgstrom Pharmacy located at 990 Pa}ve
Avenue in Saint Paul. A 16-year old male entered the store and
was able to purchase a package of Marlboro Lights without
being asked for identification. Sale of tobacco to an underage
person is a violation of Minn. Stat. §609.85 and Saint Paul
Legislative Code §324.07
Since this is a first violation, the licensing office will recommend a$200.00 fine.
At this time you have three options on how to proceed:
If you do not dispute the above facts and do not wish to have a public hearing, you will
need to pay the recommended fine for this violation. If this is your choice, you should
make payment directly to the Office of License, Inspections and Environmental
Protection, Room 300 Lowry Professional Building, 350 Saint Peter Street, Saint Paul,
Minnesota 55102. The letter should be directed to Ms. Christine Rozek. Payment of the
fine will be considered to be a waiver of the hearing to which you aze entitled.
Page 2
Peter Amundson
March 5, 2001
o�-�r1
2. Altematively, if you do not dispute the above facts, but wish to have a public hearin�
before the Saint Paul City Council, you will need to send me a letter with a statement
admittin� the violation and requesting a public hearin�. We �vill need to receive your
letter by Thursday, Mazch 15, 2001. The matter will then be scheduled before the City
Council for a public hearing to determine what penalty, if any, to impose. You will have
an opportunity to appear before the Council and make a statement on your own behalf.
3. If you do dispute the above facts, a hearin� will be scheduled before an Administrative
Law Judge. At that hearing both you and the City will be able to appear and present
witnesses, evidence and cross-examine the other's witnesses. The St. Paul City Council
will ultimately decide the case. If this is your choice, please advise my legal assistant,
Peter Pangbom, and we will take the necessary steps to schedule the administrative
hearing. He can be reached at 266-8710.
If we have not heard from you by Thursday, March 15, 2001, we will assume tLat
you do not contest the facts and witl schedule this matter for the St. Paul City Council and
have it placed on the Consent Agenda during which no public discussion is allowed and the
recommended penalty will be imposed.
Please be advised that the clerk who was identified as havin� made the sale on this date is
also being chazged an administrative penalty pursuant to Minn. Stat. §461.12, subd: 3. This is a
separate action from this license matter. If you have any questions, please feel free to contact me
at (651) 266-8710.
Sincerely,
f/ `��V cr__(����
�
Virginia D. Palmer
Assistant City Attorney
cc: Roger Curtis, Director of LIEP
Christine Rozek, Deputy Director of LIEP
Paul Maruska, Community Organizer, Payne Phalen District 5 Plannin� Council, 1014
Payne Ave., St. Paul, MN 55101
0�-7�'4
STATE OF MINNESOTA
COUNTY OF RAMSEY
ss. AFFIDAVIT OF SERVICE BY MAIL
JOANNE G. CLEMENTS, being first duly sworn, deposes and says
that on March 6, 2001, she served the attached NOTICE OF VIOLATION
on the following named person by placing a true and correct copy
thereof in an envelope addressed as follows:
Peter Amundson
Borgstrom Pharmacy
990 Payne Avenue
St. Paul, MN. 55101
(which is the last known address of said person) and depositing the
same, with postage prepaid, in the United States mails at St. Paul,
Minnesota.
Subscribed and sworn to before me
this 6 day of March, 2001.
v �_ _ __ .. �,M-:..:..�-�. .
� �=.9`�-� °ETcv � PAirG'B6Rt� >
Notary Public �;��:�t�s 11 CTFtiYFU81JC-R�1iNN.SOTH
�Y �:.,k;�. t4'r:AA.j�,ltSSICN �
'�;°.. -• `' _X.I�aqES JAN. 3?. 2'�1;5 �
- .'s^;m--�:��s�¢^c.�-�es^—se,nm�-n--�i
o�_0�'9
,,�
, �'.
�
o�
;a�
,x,
� W I
p �'I r�n I
C i�
d p '
R J ��
n. ko
�'o
�
0
(].
�
C
O
A
�
L
W
�
d
N
c
V
J
r-,
'y I
��
'��
iNI
I
uQ
N
;�m
i� I�
: a �.,
IF '
!��a�
N :a
�
�U��
'J IN
_Q
e ,s ;
0
v
R !Z
N OJ
U �
J :O
I�
a
�
��
r jQ
I
� �' �y
� IQ
� a
�l O
� �
Q
�
Q
2
d
N �
I I�
m �
z�
�Q i�
m
� j �
O
��
Z
O
�
�
� Z
E �
'�i�
�Z
ICI
I ��W
N H
!d I W
` a
IU'
C
��
iV
I•N i
Igo
i�
I I
I��
,
�i
l Q !
X�
w�
N
C
I�
�
�
Z
U
0
�a
IU
c
I�
��I
i�
�
Z '
; �,,
c�
i oa �
E
o ,
U
U.
C
N,
�ry
Ci
�
��
I �I
�N
� n
i� o 0
L I�
a I w
y
d�r CI
.= I �_
m'��
� �
, x �
1 �° I o
C�J
_I,�
! ',
i
�,
�U
iN,
O
U,
m
N
C
`� Z
mO
Z Q
¢ }
W d
W p
`a�
� I
!NI
'.o
'oi
C
�I
�i
;�
I O �,
UI
I � � �
� o � y Q a �
� I L
I ��� U �7 Y ..�. N ' N
� � O N � 1� Q tn
I � � '� Y N °� �- y
�1 Q � O7 � V � fl. �.�
� '`�- O CV '� N Q O�
,, ' � � ti �� U ����
i , N � � Y O � J � Q �
• �� U� 41 � CJ i m O�
. , ` � L U O �7LH�m
� O UC? � � � � rnLL �o
� ' Q'6 C N V C U � N V V c
'' V o°c� mc�i a� m�°
Eo_��u� 'Q� � y���
y
� Q� � Q � �
O_
� d � N
' � O i O� U� O �� C
�"�03 po U ��a�m
. (pp'OOY V V J
OO�UN �(�j CYJ '~�
� '�N .oV �W' �NOO
�waU $ m -� � cu- �
�'- p°� - o o O� j� i� c� �
NchQ'o- N� N N N C cJ
U o U �'� �a� m=U�oa�i
o�. o'm
z�FLLa a rn�...moy
�.-.-`Ko� fl.��ox��
� O_ � N �'-� O_
O 00i6 ��
N�NN � � � p C�
m�� rn or- w
. O �N�O�ON �'j�� aN
' M`NN��JWI�U7�C�N I�
_ oEoo�sa�ootqmwco�ss�o
�
:�
o.
Q
X
,� W �,
""' N N
fV � C ;O
� IU N
� IJ I�
R M
a m
_'o
r
O
Q
d
�
C
O
.�
�
�
w
C
d
N
C
d
U
J
�
O
�
�
i
��
I� I
�IN
C N
I V >
U
IJ , , i Q
fl.�
I�,
� �U
I��
i u�i '� a�i
U
J I O
_,�
.�o
�
�
Z '
C , C�D
iVl�
J' O
�
I i
N
I ��
W
�
Q
�N Z
}
i"O Q
a
�¢
� O
I ` m �
Q
�
�
_
i :
id',�
Z �
m �
0 O
_m
Z
O
�
— Q
N 7
Z �
Q
� W
a w
_a
�I
U
i�
�
O I iU
C
!N
o io
I
i I
'�I
�p I
d
iW ,
�INj
�1
�
�I �
I I�
N
�
I !
IU I
�I
a
Ui
N
�,
��i
IC'
�
�
W
Z
T
c
�'
Q
O
U
VI
C'
m
3'
�I
�
�
Z
i�
'��n
;O
L i�
a �
NI �
�,n
S'�
3 �
m �
i
0 �
N O
M
7
��
�I
I
I
�
i U ,
C�
�
�'
I NI i
�
I'N '
m �
Z Q
�, Q Z
wa
w°
_a rn
I � � �
� �
O � N Q a (n
U � d � ' C
� ��6 O N � \ � N
I S " M � tJ tfJ d i d
O
�.- O NQO�
�. O U 1� C�ID U � C_
� i � � N � @C � D ��
41 y :0 � J Q�
i N Q.�' V� � U � O�
. O Q Y O 4t H c0
' �a C7 rn mo
i O - V (6 y L LL �
� ' Q'O C N V U U o NCjUs
�', I U ( 6 U N (O h„'N
'� 0. U l4 � C C � W � L
� i � N m O.� �� � ��� U
� � N E = N – N
a � O m
�n E �n o � �
� i c o� o m o� o � � c
' °"�� 0o U n�
, � 'mo � �Y � o �J�
U N
�� � 0� U N l9 p CYJ � L�
i� ', ;� O� U O� .�� C � LL U
� �, D� � O O�
I NMQ'O'—� N� Nd NCU
�, UOU�C �N"O 'D=�.!:LL"6
� �ON� (6 t�n � U ��r�n
': Z CHIL Q Q. N Q�=(60y
' a ��. - ��'oo_ �a�ia���n
i O?OO...QO �U
' O O O(6 O� E m�
, N�NN V N� � C ' � C�
E��� rn o �o�y�
' ° ° r•��o o_N
' C C�N �I�
_' O EOOEA�IJOO[n(DWcOEA—O
o�.��
p�_7Pq
',��
,��
,�,
,a
� 'W ',
� i�;O
co ,�,o
d ' V N
�'_
a I IN
1 `
�
0
a
d
�
c
O
.�
�
�
w
c
d
N
C
N
V
J
N
��.. I
,m
���!
i
Ia�il>
i
�Q
I � i
i p N
���
a�I�m
Cla
V N
..J ' (9
_'LL
� �
o �
� �
� �
Z.
N N
C '(D
U �
J'O
I
I �
��
_Q
'N w
i� }
���
a
I_� �
Q
�
�
_
�d
� �
�
�Z �
iQ �
m �
� O
_ m
Z
�
�
—�
N =
Z �
Q
O W
a w
— a
��
IU
IJ
IO�
�U j
�
� N 'I�
� O
I�
I I
d�
I �
Q �
I
Iw I
Ni
�I
I
�
�
N
4
I3 �
Z
IU I
� i
�i
Ic'
N'
i
ICI
��
E
m
Z,
T
@,
Q
0
U
�
U
C
N
�,
Iy
C
-
m�
�i
�I
= I
Z
N'�
� O
L �
a lo�
N
N ^
N
C i
7 ',LL�
m �
�,�
X'.O
~ M
V
—'�
�
�
�
I
�
I ;
�:
iN
U'
INi
iy .
i �'
�
m �
I � Q
I Q Z
i }
I W O
i w
_a rn
i
N
CI
.O
�I
C
O
NI
�'
U:
' � � a tA
i � � d
N N (6 fn
�' a. a
i U � ` d � C
' @ m O a� � � O N
' I� -p O� V � Q d
� I � �N � J NQO�
I o ,°�r tAm U ��,.� c_
I � � N �� ����
� � � �
�� m a� so � Q�
�� N �� V� � Y O � O�
I, O D U U� V� �� LL y p
� L m �
�Q"OCNV UV o NC�CJ
' I Uooc� m� ` co �'��
I O N��� Q'm C ��OU
OQ2� �6
�� �� N E(� O �- C � N � U
' C O O N V� O �� C
°_"�03 po U d�a�m
(6 'O O Y U V J L �-
ON�VN N� C`1J �
>�°�V o� ' �=�cLL�
�` �« "O O O �LLLL N �
N(`'J Q'6 - N+' N N N C U
�oU�� y a=o>wu.
o°om� mr�n � V��ai
z�F-tifl- ay Qcco�N`�
���`�oo_ 7a�m'_F»o_
° o' -O O ° o m ' E� mrn
. N� N N� U N� � C � C�
cp �� OD O i� v�
', O C�NQ�ON i� j�0 O_N
M' C�N I�
_. o Eoov��noov�cowcoF»�o
�'
o;
a
;x
N W :
p �ai.N
O
�f � O
d i p N
R I � J M
a �o
0
a
d
�
c
0
.�
E
L
V
c
d
N
C
d
i.l
J
�
O
�
v
�''�
�
I �
�I
I�
IJ¢
� iU
y
i�:�
� T.�
� I�
i�
iC��
i�.�
i U ; (0
J �
;_U
I�
�
E
��,
Z,
I �U �
IJ , O
�
I �NI
��
�,w
i Q
i y �
!� Q
4 0
�
Jrn �
Q
�
�
Q
2
�I �
i�!�
Z �
�
� I�
�
_ m
Z
�
�
NIZ
E�'�
m
ZiQ
O,
a w
_;a
.U)
IC�
' �I
�I
�'O O
i '
��I
m
, a l
x
W
m
I �
�
�,
� i
i �,
C
@
Q
�,
o;
U'
a�
U,
�
N
yi
I�,
�
��
i� ;
�7'
i Z i
� i
Ic
'o 0
IL ��
d �
N �
N'�
c �
�',�
m�
'O �
F o
M
— �
I
�
iyl
iR�
I
iCi
O
N I
m
N '
C'
,tN Z
m �
Z Q
' 'Q >
�w a
� ;W �°,
i—a rn
I
,
I � � � �
I � � N N t6 f�
o � a a
.� Y � � C
ro (6 O N � � � N
�r W' �
I I O �M � U tn Q� �
C � N Q p �
� � �� �� U ���rn
d R��rn
� � i� � JrQ�
I �'I N �� V� y U � O�
�' �VUL� Uy U �LLtpO
��,p _om �t rn�
Q"OCNV UV ° NUU
I '' � ° o_� m� � c c �a'Or
� yN=d O-� ���U
�I � O U � O ���C
°-'">�3 0 o U ��a�m
'I (p p'a 0 Y V V J L �-
� ON�UN ( V CYJ � ~ E
� > i.n ��U p m .°-�� c cii c
�, O`_'Ow -� � O�LLLL N�
��Q'6� N+' NN NCU
� U�U N � N'� "O= �."-.LL'O
O N i6 N N
� Z �Fti fl- d w rn�°U `mo o,
�.-� L� m nc � o��m
Q n � a� � o.
° 0�9 ° oomV ° orn E o�rn
N NN NOl � C �m
' �c0�� � OI�
; ' OCN\��ON �
c")" C�N �1�
�_ O�OOfAl1�00lQtDWCOER—O
oi-sY1
�, .
�.
��
;n;
� ' I
�.. N i,
� ICi�
� ; � I o
d i C) N
l�6 �� IM
d I ;M
_o
�
C
�
c
O
R
�
L
W
C
N
N
C
d
U
J
�
O
a
v
N I
I�
jN,
j� ''
N d
I � U
� �
U �
�I� jU
- � N
iyi�
d �
�F �O
� !U
c;m
�,:�
IV ;p�
I J'O
a '
E
3,
IZ ,
N'�
N �
IUI�
J O
r1
�I
i�
I,�I�
� —,w
� I�
iQ
��IZ
i}
I� �
� ia
,¢ lo 0
rn�
�� �
Q
�
�
Q
_
a
i���
�'��
Z ��
�a :�
� ;�
i�
_ m
Z
O
�
N
E',�
m.�
Z'
G , Q .
0
W
a,a
�C ,
i
ID
I V I
IVI
I � N I�
I� o
�
'�
i
Q i
iW �
I�i
I��
�
i '?1
�Z I
IU'
a'
iV
C
,m�
INI
IC',
i=,
�,
�E
(6
Z
T
c
N
d
�
0
U
�
V
C
N'
�
N
C
I I9 ;
3i
�N
iCl�
�
� I �
Iy
N
d
��
I�I� �
� �
I�
� 1 O
M
�
��
I '
I '
' I
w
IU
�,� '
Im
N'
�
.
m 0
� Q
I Q }
wa
w
' arn
yI
�'�
o,
al
c�
O
N
�I E
0
U
N � .p (�
I O � N O_ d �
I U � i «� N ' C
' V '�6 O N G � � N
� -p M � V ti� d i �
� C � N Q O '
o � �c° U Q � ��
N @���
� y �
� Y� � J Q�
� O� V � � U � m O�
O 3tH�
I w UUt� � � � `� v�o
� - U(0 47 L a1
I Q C N V U V 0 \UUY
i V o°�� m� � mr"-a
� N�� N Q C ?�� U
i� E= w° c�
o�o� o� � 0���
i o���3 0o U d�a�m
.(6p"O OY V V J p_
�� OO�UN N V CYJ � ~ E
�NQ(6 �U ��' �NOO
tD�--Q � (6 ' � � Cll V
o�� ao ��
c v
UOU N C N"6 "6= m�LL'O
o°om� mu � U��v�i
�' z �i-u. X- d� nc c mc �
� d �� . �a� a � a�� �a
� o� mU � � � o �rn
I � � � �mO O�
, O CNN� ON �'j�� Q N
� M' ��N f�
! o Eoo��nooa�cbw�<»�o
0�_��4
OENVRON:�IE�TALEPROT[CTIO;7SAND Ot�1�0
l
Rogcr G««s, Drreclor
CITY OF SAINT PAUL
Namt Colenrnq .11m'or
Case #
BORGSTROM PHARMACY
990 PAYNE AVE
ST PAUL, MN 55101-3902
License Type: License #
CigarettelTobacco 0016685
LOII'RYPROFESSIOn.iL 8L'ILD1.4'G Telrphane: GS/-1GG-9090
350 St Peter S+rcet, Sxite 300 Fuaimrlr: 6.i1-?6G-9/?4
SnintPnul.dlirsioesatn5=10?-/S/0 I(Yb: �nnr.tis�pnuLnuo.us'li�p
Tobacco Compliance Check Purchase Form
� For O�ce Use Only
Compliance Check [.D.n
6usinais i.D. °
Pre Ordinar.ce
_ Post Ordinance
Business Type:
� Concenience � Convenience / Gas � Gas f-�'Dcug Store / Pham�acy � Tobacco / Smoke Shop
!
� Supern�arket / Grocery � General Merchani � Liquor Store / Bar Restaurant � Ol11ef �priratc dub, bowiing, a:c )
Q� �� � o � � : C] �
Date• Time: ( a.m. / .m
M M D D
\�'as p rchase attempted?
�-]'-}'Ces �Na
l
Bu�er � � �
Use 3 initials
�
IS
6
17
R'a sale ntade?
Yes or ho
��
If NO, cIieck rcason:
� Does not sell tobacco � Unsatisfactory/unsafe conditions
� Out of business � Other
� After business ltoucs � Not applicable
Sex Adult ��� Did adult or offcer ��ie�c Vansaction'.
Fe ale Use 3 initials Yes or I�'o
Ma]
R'as age as ' R'as ID requestcd' ��'as ID slion '
Yes or � Yes or �o '_ Yes or No _
Tppe oC purchase:
� elf Service
Clerk assisted
Vendine �nachine - Unlocked
Location of machine
_Vending machine - Locked
Location of machine /
Clerk Information: � ,� Fema4e � Male
T�'p of product: Amount spent: S❑�
_C�garettes �1/fR�-t�Oh �.�
_Smokeiess �
_Other (cigarette papzrs, li�htzr,
Civil Penalty S
Limnser. Ci�il Pznalry 5
Far Offce Ose Only
Appruximate Age: � Under 18
Criminal Penalty S
Suspension:_10 days or Izss
_3? d��5 to ! itar
� u
r �
Actual age if knov�n ���u'�t/�
� and
ii O�er
I 1 to 3l da�•s
_O�er : year
o►-s�'!
I�Tame.of
�.4��/li.c� U��
--� �� ���
Date ofBirth
��a� /�'Z�k' � wl
���R�- /�lt'�,��
Address:
'V �iY�'9L `1
����
���h°s'�>3-j
Driver's License # or State I. D.#:
G 5�ti� � �� ,
; � ��� �-
L �� '
License Group Comments Text
02/28/200'I
Licensee: pETER AMUNDSON
�BA� BORGSTROM PHARMACY �t '� g1
License #: 0016685
OZ/28/2001 To CAO for adverse action., CAR
02/27l2001 Failed tobacco"compliance eheck. Second faiiuire -$400 matrix penalty. Clerk was Rebecca Grimes, 723 York 55106 CAR
08/03/2000 Passed tobacco wmpliance check. SS � -� _. ' _ � . - ' �
07/28/9g passed tobacco compliance check - 08/16/99 letter sent SS
6-17-99—Upgrade Originai Container to Grocery-C License per Environmental Health—Ik
Insp Change From Ot To 02 On 3/20/92 6/5l97 - Sent Cig. Fine Letter (Due 6/27/97) - Lab 6/25l97 - Paid 5200.00 Cigarette Fine - Lab 5/28/97 C.F.
#97-G53 App'D Imposing 5200 Fine For The Sale Of Cigs To A Minor
07l28/99 passed cig compliance check - 08/11/99 Ietter sent SS
o�_��[
�_ _
s Sta�4 .6rou C+�J�se ^�; �ECt �.�`EG��F�e�,e„h...� �erue�Que.�+� � , � �- : ,��'i � �p ��t. '� 1027A63
�... :� P� �.-; �,...,�„� , .,.�.,. s,t v�� ,� � z`��+�2€3%.���.��
..�,�L.�' ..a- .. _
o�.��'1
Addre
Typt
SYre
SYre °
SYre
Dire�:
_ ;
Unit ;
Cdy�
!
s
S
t
r—:
�
�:�+ ��� . *�"�' �.'�'j; Lice�ee ETER RtJiUNOSON
?ay Pnm , A�sc� �t4st� ,�Su�w%�; DBA ORGSTROM PHARMACY
License � Licensee � Lic. Types � Insurance � Bond , Requiremerrts)
� Property �' Licensee C� Unofficisl Project Facildator. ASUNCION, CORINNE ��",'�
Sfreet #: 90 Adverse A ction Commer25
SYreet Name: AYNE '
.. . .___ ,,,.._._____�...____ ___..:
SYreet Type: AYE Diredion: ��
UnR Ind: � UnR #: �! - -
City. T PAUL License Group Commerrts:
State: u1N - Zip: � 55101, 2n8n001 Failed tohacco compliance check. First
� ailure since 1997 -$200 matrix penatty. Clerk was
Ward: ebecca Grimes, 723 York 55106 CAR
Dist Council: �5 8J0372000 Passed tobacco compfiance check. SS
-- 7fZ8P39 passed tobacco compliance check - 08t16I99
Licensee: ETER AMUNDSON l Licensee
�__.. ...__.___... _.._......._._..._...
DBA: ORGSTROM PHARMACY i Commerrts�
Sales Tax Itl: 430-0OS Bus Phone: 651) 771-8807 :`
Lice��: Licens�gTgpe:?.�5'�
1432<j False Alarms �
Alarm Permit (Ren
'1668°i Original Corrtainer
�! License # 6685
12F3il2000
UtilUyfl`Jy8 ; 06109R001 N $10.00
0'I t28M 997 � 03f312000 _ N ] $50.00
Save Changes to History
1027
o�-��t
TypE ?9':R�-���m `�; l' i F�� �% ,� Licensee ETERAMUNDSON
'� j DBA ORGSTROMPHARMACY
Stre
Stre � License Licensee � Lic. Types � I�urance � Hond l ftequiremeMS �
aA-�:._._.:.n.,'� -.
SYre � Licensee Name: ETER AMUNDSON ,:��•�� �t.
=.7z _ � :u:..."z'f L
Dire� DBA: ORGSTROM PHARMACY
Unit ' , p: � �Pi�o e tj s:s�'z �
: Sales Tax Id: 430405 ; Non-Profd: � Worker's Com ONON000
� AA Contract Rec'd: ONOr0000 _, AA Training Rec'd: OIOON000
CRy
, AA fee CoVlected: ONOND00 _ Discourrt ftec'd: �
= Other Agency Lic enses Financiai Hold Reasons
' QliSer Li4 t�*� ;m:..9.e.. eJ1PXd�..," , �1��� i � : � �` �.�� �so_ ,.. :��-'� `, ,,,y ' �f ° �c�.� „ ut� § ���ve�',°_ . ���' �:�:
� � �
�Mail License Ta: —
� Mail To CorRact
�' License Address
1668
Background Check Requiretl r
x��: ����
�Mail Invoice To: —
�` Mail To Co�ad i
�' License Address �
License #
Save Changes to History r
'`�' �
1027AM
Council File # p ��'3 j'y
Green Sheet # � p O G 3.S
Presented By
Referred To
Committee: Date
RESOLVED, that the licensee, Peter Amundson, d/b/a Borgstrom Pharmacy (License ID
No. 16685), located at 990 Payne Avenue in Saint Paul is hereby ordered to pay a fine of
$200.00 for the violation of the sale of tobacco or tobacco products to a minor.
Said fine shall be paid to the Office of License, Inspections and Environmental Protection
within thirty (30) days of the adoption of this resolution by the Council and signature by the
Mayor.
This resolution and the acrion of the Council in this matter are based upon the facts
contained in the Notice of Violarion letter to the licensee and the Tobacco Compliance Check
Purchase Form. The facts were not contested by the licensee.
Requested by Department of:
Adopted by Council : Date � �, �j(' �-OC� \
Adoption Certified by Council Secretary
By: ItiltGCC�. � � so
Form Approved by City Atto
BY. ✓ /
Approved by Mayor for Submission to
Council
BY � o \ � _ _ '1� .-�
��� g � By :
Approved by Mayor: Date /� 6E�
sy:
6
RESOLUTION
CITY OF SAINT PAUL, NIINNESOTA
�A
coun��i
�
io, Zooi I GREEN.SHEET
o l -38q
No1uu�35
)er noscrom Ucf.��rowgro. Varrm.c�—
AG@aA BY (��
AEi1fiN
��OL � Ci n ent IOAWBIFdt ❑CIIYAiIOAEY fJ1YClH11[
�
� a�,�.� .�.,�
❑ r�v°rtfae�amn"p ❑
TOTAL � OF SIGNATURE PAGES (CLIP ALL LOCATIONS FOR SIGNATUR�
Reco�ending that the licensee,. Peter Amundson, dba Borgstrom Pharmacy, 990 Payne Avenue
pay a fine of $200.00 for the violation of the sale of tobacco or tobacco products to'a
minor.
PLANNING CAMMISSION
CIB COMMITTEE
CIVIL SERVICE COMMISSION
OFTRANSACTION
SOURCE
rms uie a��� eve.xa�d unae. a cardrad rarenis depaemenn
YES NO
Hm Mia pnawJfirm aver heen a WY �DbY��
rES rio
Does thie ce�� a� a s16N rat iarma�No�aseaseC DY anY arte�d cnv emdovee4
YE4 HO
b thic pe�aoNfxm a targeted �eiMol7
VES NO
ilein aP vecarrewe�s on aeoarate sf�ee.t end atlech to arcen si�eet .
cosrmEVO+uE auocterm lq�tctR ot�7
ACTIVITYNUMBER
YES NO
�
01-��`y
UNCONTESTED LICENSE MATTER
Licensee Name:
Address:
Council Hearing Date
Peter Amundson, d/b/a Borgstrom
Pharmacy
990 Payne Avenue
Wednesday, April 18, 2001
Violation: Sale of Cigarettes to a Minor
Minn. Stat. § 609.685
St. Paul Legislative Code § 324.07
Date of Violation:
Place:
Presumptive Penalty:
February 27, 2001
Licensed Premises
$200.00 Fine
Recommendation of Assistant City Attorney on behalf of client, Office
of License, Inspections and Environmental Protection:
$200.00 fine (first offense)
Attachments:
1. Proposed resolution
2. Notice of Violation
3. License Information Report
4. Tobacco Compliance Check Purchase Form
5. License information
CITY OF SAINT PAUL
Norm Co[eman, Mayor
Apri13, 2001
Peter Amundson
OFFICE OF THE CITY ATTORNEY
C/ayton M. Robinson, Jc, Ciry Attorney 0`„', �
Civil Division
400CiryHa11 Te(ephone:651266-87l0
ISWutKelloggBlvd. Facsimile:651198-5619
Snin! Paul, Minnesota 55102
NOTICE OF COUNCIL MEETING
Borgstrom Phannacy
990 Payne Avenue
Saint Paul, Minnesota 55101-3902
RE: Cigarette/Tobacco License held by Peter Amundson, d/b/a Borgstrom Pharmacy for the
premises located at 990 Payne Avenue in Saint Paul
License ID #:16685
Dear Mr. Amundson:
Please take notice that this matter has been set on the Consent Agenda for the Council meeting
scheduled far 3:30 p.m., Wednesday, April 18, 2001 in the City Council Chambers, Third
Floor, Saint Paul City Hall and Ramsey County Courthouse.
Enclosed aze copies of the proposed resolution and other documents which will be presented to
the City Council for their consideration. This is an uncontested matter in that the facts contained
in the Notice of Violation concerning the unlawful sale of cigazettes have not been disputed. The
recommendation of the license office will be for a$200.00 fine.
If you have any questions, please call me at 266-8710.
Very truly yours,
���� �����
�
Virginia D. Palmer
Assistant City Attorney
cc: Nancy Anderson, Assistant Council Secretary
� yb a —�fZ;'
�5��;:,_ . �. _�. ..
° �� � � E��ii
�:3 .#
Roger Curtis, Director, LIEP
Christine Rozek, LIEP
Paul Maruska, Community Organizer, Payne Phalen District 5 Planning Council, 1014
Payne Ave., St. Paul, MN 55101
OFFICL �r THE CITY ATTOR��IEY
C[ayton M. Robinsan, Jc, Ciry Anorney Q,�� Y4
CITY OF SAINT PAUL
Narm Coleman, Nf¢yor
Mazch 5, 2001
Peter Amundson
civit Division
400 City Hnl!
1 S West Ke11og; Blyd.
Saint Pauf, hlinnesotn 55/0?
NOTICE OF VIOLATION
Borgstrom Pharmacy
990 Payne Avenue
Saint Paul, Minnesota 55101-3902
Telepkone: 651166-8710
Facsinaile: 651298-5619
RE: Cigarette/Tobacco License held by Peter Amundson, d/b/a Borgstrom Pharmacy for the
premises located at 990 Payne Avenue in Saint Paul
License ID #:16685
Dear Mr. Amundson:
The Office of License Inspections and Environmental Protection has recommended
adverse action against the cigazette/tobacco license held by Peter Amundson, d/b/a Borgstrom
Phannacy for the premises located at 990 Payne Avenue in Saint Paul. The basis for the
recommendation is as follows:
On February 27, 2001, a tobacco compliance checic was
conducted at Borgstrom Pharmacy located at 990 Pa}ve
Avenue in Saint Paul. A 16-year old male entered the store and
was able to purchase a package of Marlboro Lights without
being asked for identification. Sale of tobacco to an underage
person is a violation of Minn. Stat. §609.85 and Saint Paul
Legislative Code §324.07
Since this is a first violation, the licensing office will recommend a$200.00 fine.
At this time you have three options on how to proceed:
If you do not dispute the above facts and do not wish to have a public hearing, you will
need to pay the recommended fine for this violation. If this is your choice, you should
make payment directly to the Office of License, Inspections and Environmental
Protection, Room 300 Lowry Professional Building, 350 Saint Peter Street, Saint Paul,
Minnesota 55102. The letter should be directed to Ms. Christine Rozek. Payment of the
fine will be considered to be a waiver of the hearing to which you aze entitled.
Page 2
Peter Amundson
March 5, 2001
o�-�r1
2. Altematively, if you do not dispute the above facts, but wish to have a public hearin�
before the Saint Paul City Council, you will need to send me a letter with a statement
admittin� the violation and requesting a public hearin�. We �vill need to receive your
letter by Thursday, Mazch 15, 2001. The matter will then be scheduled before the City
Council for a public hearing to determine what penalty, if any, to impose. You will have
an opportunity to appear before the Council and make a statement on your own behalf.
3. If you do dispute the above facts, a hearin� will be scheduled before an Administrative
Law Judge. At that hearing both you and the City will be able to appear and present
witnesses, evidence and cross-examine the other's witnesses. The St. Paul City Council
will ultimately decide the case. If this is your choice, please advise my legal assistant,
Peter Pangbom, and we will take the necessary steps to schedule the administrative
hearing. He can be reached at 266-8710.
If we have not heard from you by Thursday, March 15, 2001, we will assume tLat
you do not contest the facts and witl schedule this matter for the St. Paul City Council and
have it placed on the Consent Agenda during which no public discussion is allowed and the
recommended penalty will be imposed.
Please be advised that the clerk who was identified as havin� made the sale on this date is
also being chazged an administrative penalty pursuant to Minn. Stat. §461.12, subd: 3. This is a
separate action from this license matter. If you have any questions, please feel free to contact me
at (651) 266-8710.
Sincerely,
f/ `��V cr__(����
�
Virginia D. Palmer
Assistant City Attorney
cc: Roger Curtis, Director of LIEP
Christine Rozek, Deputy Director of LIEP
Paul Maruska, Community Organizer, Payne Phalen District 5 Plannin� Council, 1014
Payne Ave., St. Paul, MN 55101
0�-7�'4
STATE OF MINNESOTA
COUNTY OF RAMSEY
ss. AFFIDAVIT OF SERVICE BY MAIL
JOANNE G. CLEMENTS, being first duly sworn, deposes and says
that on March 6, 2001, she served the attached NOTICE OF VIOLATION
on the following named person by placing a true and correct copy
thereof in an envelope addressed as follows:
Peter Amundson
Borgstrom Pharmacy
990 Payne Avenue
St. Paul, MN. 55101
(which is the last known address of said person) and depositing the
same, with postage prepaid, in the United States mails at St. Paul,
Minnesota.
Subscribed and sworn to before me
this 6 day of March, 2001.
v �_ _ __ .. �,M-:..:..�-�. .
� �=.9`�-� °ETcv � PAirG'B6Rt� >
Notary Public �;��:�t�s 11 CTFtiYFU81JC-R�1iNN.SOTH
�Y �:.,k;�. t4'r:AA.j�,ltSSICN �
'�;°.. -• `' _X.I�aqES JAN. 3?. 2'�1;5 �
- .'s^;m--�:��s�¢^c.�-�es^—se,nm�-n--�i
o�_0�'9
,,�
, �'.
�
o�
;a�
,x,
� W I
p �'I r�n I
C i�
d p '
R J ��
n. ko
�'o
�
0
(].
�
C
O
A
�
L
W
�
d
N
c
V
J
r-,
'y I
��
'��
iNI
I
uQ
N
;�m
i� I�
: a �.,
IF '
!��a�
N :a
�
�U��
'J IN
_Q
e ,s ;
0
v
R !Z
N OJ
U �
J :O
I�
a
�
��
r jQ
I
� �' �y
� IQ
� a
�l O
� �
Q
�
Q
2
d
N �
I I�
m �
z�
�Q i�
m
� j �
O
��
Z
O
�
�
� Z
E �
'�i�
�Z
ICI
I ��W
N H
!d I W
` a
IU'
C
��
iV
I•N i
Igo
i�
I I
I��
,
�i
l Q !
X�
w�
N
C
I�
�
�
Z
U
0
�a
IU
c
I�
��I
i�
�
Z '
; �,,
c�
i oa �
E
o ,
U
U.
C
N,
�ry
Ci
�
��
I �I
�N
� n
i� o 0
L I�
a I w
y
d�r CI
.= I �_
m'��
� �
, x �
1 �° I o
C�J
_I,�
! ',
i
�,
�U
iN,
O
U,
m
N
C
`� Z
mO
Z Q
¢ }
W d
W p
`a�
� I
!NI
'.o
'oi
C
�I
�i
;�
I O �,
UI
I � � �
� o � y Q a �
� I L
I ��� U �7 Y ..�. N ' N
� � O N � 1� Q tn
I � � '� Y N °� �- y
�1 Q � O7 � V � fl. �.�
� '`�- O CV '� N Q O�
,, ' � � ti �� U ����
i , N � � Y O � J � Q �
• �� U� 41 � CJ i m O�
. , ` � L U O �7LH�m
� O UC? � � � � rnLL �o
� ' Q'6 C N V C U � N V V c
'' V o°c� mc�i a� m�°
Eo_��u� 'Q� � y���
y
� Q� � Q � �
O_
� d � N
' � O i O� U� O �� C
�"�03 po U ��a�m
. (pp'OOY V V J
OO�UN �(�j CYJ '~�
� '�N .oV �W' �NOO
�waU $ m -� � cu- �
�'- p°� - o o O� j� i� c� �
NchQ'o- N� N N N C cJ
U o U �'� �a� m=U�oa�i
o�. o'm
z�FLLa a rn�...moy
�.-.-`Ko� fl.��ox��
� O_ � N �'-� O_
O 00i6 ��
N�NN � � � p C�
m�� rn or- w
. O �N�O�ON �'j�� aN
' M`NN��JWI�U7�C�N I�
_ oEoo�sa�ootqmwco�ss�o
�
:�
o.
Q
X
,� W �,
""' N N
fV � C ;O
� IU N
� IJ I�
R M
a m
_'o
r
O
Q
d
�
C
O
.�
�
�
w
C
d
N
C
d
U
J
�
O
�
�
i
��
I� I
�IN
C N
I V >
U
IJ , , i Q
fl.�
I�,
� �U
I��
i u�i '� a�i
U
J I O
_,�
.�o
�
�
Z '
C , C�D
iVl�
J' O
�
I i
N
I ��
W
�
Q
�N Z
}
i"O Q
a
�¢
� O
I ` m �
Q
�
�
_
i :
id',�
Z �
m �
0 O
_m
Z
O
�
— Q
N 7
Z �
Q
� W
a w
_a
�I
U
i�
�
O I iU
C
!N
o io
I
i I
'�I
�p I
d
iW ,
�INj
�1
�
�I �
I I�
N
�
I !
IU I
�I
a
Ui
N
�,
��i
IC'
�
�
W
Z
T
c
�'
Q
O
U
VI
C'
m
3'
�I
�
�
Z
i�
'��n
;O
L i�
a �
NI �
�,n
S'�
3 �
m �
i
0 �
N O
M
7
��
�I
I
I
�
i U ,
C�
�
�'
I NI i
�
I'N '
m �
Z Q
�, Q Z
wa
w°
_a rn
I � � �
� �
O � N Q a (n
U � d � ' C
� ��6 O N � \ � N
I S " M � tJ tfJ d i d
O
�.- O NQO�
�. O U 1� C�ID U � C_
� i � � N � @C � D ��
41 y :0 � J Q�
i N Q.�' V� � U � O�
. O Q Y O 4t H c0
' �a C7 rn mo
i O - V (6 y L LL �
� ' Q'O C N V U U o NCjUs
�', I U ( 6 U N (O h„'N
'� 0. U l4 � C C � W � L
� i � N m O.� �� � ��� U
� � N E = N – N
a � O m
�n E �n o � �
� i c o� o m o� o � � c
' °"�� 0o U n�
, � 'mo � �Y � o �J�
U N
�� � 0� U N l9 p CYJ � L�
i� ', ;� O� U O� .�� C � LL U
� �, D� � O O�
I NMQ'O'—� N� Nd NCU
�, UOU�C �N"O 'D=�.!:LL"6
� �ON� (6 t�n � U ��r�n
': Z CHIL Q Q. N Q�=(60y
' a ��. - ��'oo_ �a�ia���n
i O?OO...QO �U
' O O O(6 O� E m�
, N�NN V N� � C ' � C�
E��� rn o �o�y�
' ° ° r•��o o_N
' C C�N �I�
_' O EOOEA�IJOO[n(DWcOEA—O
o�.��
p�_7Pq
',��
,��
,�,
,a
� 'W ',
� i�;O
co ,�,o
d ' V N
�'_
a I IN
1 `
�
0
a
d
�
c
O
.�
�
�
w
c
d
N
C
N
V
J
N
��.. I
,m
���!
i
Ia�il>
i
�Q
I � i
i p N
���
a�I�m
Cla
V N
..J ' (9
_'LL
� �
o �
� �
� �
Z.
N N
C '(D
U �
J'O
I
I �
��
_Q
'N w
i� }
���
a
I_� �
Q
�
�
_
�d
� �
�
�Z �
iQ �
m �
� O
_ m
Z
�
�
—�
N =
Z �
Q
O W
a w
— a
��
IU
IJ
IO�
�U j
�
� N 'I�
� O
I�
I I
d�
I �
Q �
I
Iw I
Ni
�I
I
�
�
N
4
I3 �
Z
IU I
� i
�i
Ic'
N'
i
ICI
��
E
m
Z,
T
@,
Q
0
U
�
U
C
N
�,
Iy
C
-
m�
�i
�I
= I
Z
N'�
� O
L �
a lo�
N
N ^
N
C i
7 ',LL�
m �
�,�
X'.O
~ M
V
—'�
�
�
�
I
�
I ;
�:
iN
U'
INi
iy .
i �'
�
m �
I � Q
I Q Z
i }
I W O
i w
_a rn
i
N
CI
.O
�I
C
O
NI
�'
U:
' � � a tA
i � � d
N N (6 fn
�' a. a
i U � ` d � C
' @ m O a� � � O N
' I� -p O� V � Q d
� I � �N � J NQO�
I o ,°�r tAm U ��,.� c_
I � � N �� ����
� � � �
�� m a� so � Q�
�� N �� V� � Y O � O�
I, O D U U� V� �� LL y p
� L m �
�Q"OCNV UV o NC�CJ
' I Uooc� m� ` co �'��
I O N��� Q'm C ��OU
OQ2� �6
�� �� N E(� O �- C � N � U
' C O O N V� O �� C
°_"�03 po U d�a�m
(6 'O O Y U V J L �-
ON�VN N� C`1J �
>�°�V o� ' �=�cLL�
�` �« "O O O �LLLL N �
N(`'J Q'6 - N+' N N N C U
�oU�� y a=o>wu.
o°om� mr�n � V��ai
z�F-tifl- ay Qcco�N`�
���`�oo_ 7a�m'_F»o_
° o' -O O ° o m ' E� mrn
. N� N N� U N� � C � C�
cp �� OD O i� v�
', O C�NQ�ON i� j�0 O_N
M' C�N I�
_. o Eoov��noov�cowcoF»�o
�'
o;
a
;x
N W :
p �ai.N
O
�f � O
d i p N
R I � J M
a �o
0
a
d
�
c
0
.�
E
L
V
c
d
N
C
d
i.l
J
�
O
�
v
�''�
�
I �
�I
I�
IJ¢
� iU
y
i�:�
� T.�
� I�
i�
iC��
i�.�
i U ; (0
J �
;_U
I�
�
E
��,
Z,
I �U �
IJ , O
�
I �NI
��
�,w
i Q
i y �
!� Q
4 0
�
Jrn �
Q
�
�
Q
2
�I �
i�!�
Z �
�
� I�
�
_ m
Z
�
�
NIZ
E�'�
m
ZiQ
O,
a w
_;a
.U)
IC�
' �I
�I
�'O O
i '
��I
m
, a l
x
W
m
I �
�
�,
� i
i �,
C
@
Q
�,
o;
U'
a�
U,
�
N
yi
I�,
�
��
i� ;
�7'
i Z i
� i
Ic
'o 0
IL ��
d �
N �
N'�
c �
�',�
m�
'O �
F o
M
— �
I
�
iyl
iR�
I
iCi
O
N I
m
N '
C'
,tN Z
m �
Z Q
' 'Q >
�w a
� ;W �°,
i—a rn
I
,
I � � � �
I � � N N t6 f�
o � a a
.� Y � � C
ro (6 O N � � � N
�r W' �
I I O �M � U tn Q� �
C � N Q p �
� � �� �� U ���rn
d R��rn
� � i� � JrQ�
I �'I N �� V� y U � O�
�' �VUL� Uy U �LLtpO
��,p _om �t rn�
Q"OCNV UV ° NUU
I '' � ° o_� m� � c c �a'Or
� yN=d O-� ���U
�I � O U � O ���C
°-'">�3 0 o U ��a�m
'I (p p'a 0 Y V V J L �-
� ON�UN ( V CYJ � ~ E
� > i.n ��U p m .°-�� c cii c
�, O`_'Ow -� � O�LLLL N�
��Q'6� N+' NN NCU
� U�U N � N'� "O= �."-.LL'O
O N i6 N N
� Z �Fti fl- d w rn�°U `mo o,
�.-� L� m nc � o��m
Q n � a� � o.
° 0�9 ° oomV ° orn E o�rn
N NN NOl � C �m
' �c0�� � OI�
; ' OCN\��ON �
c")" C�N �1�
�_ O�OOfAl1�00lQtDWCOER—O
oi-sY1
�, .
�.
��
;n;
� ' I
�.. N i,
� ICi�
� ; � I o
d i C) N
l�6 �� IM
d I ;M
_o
�
C
�
c
O
R
�
L
W
C
N
N
C
d
U
J
�
O
a
v
N I
I�
jN,
j� ''
N d
I � U
� �
U �
�I� jU
- � N
iyi�
d �
�F �O
� !U
c;m
�,:�
IV ;p�
I J'O
a '
E
3,
IZ ,
N'�
N �
IUI�
J O
r1
�I
i�
I,�I�
� —,w
� I�
iQ
��IZ
i}
I� �
� ia
,¢ lo 0
rn�
�� �
Q
�
�
Q
_
a
i���
�'��
Z ��
�a :�
� ;�
i�
_ m
Z
O
�
N
E',�
m.�
Z'
G , Q .
0
W
a,a
�C ,
i
ID
I V I
IVI
I � N I�
I� o
�
'�
i
Q i
iW �
I�i
I��
�
i '?1
�Z I
IU'
a'
iV
C
,m�
INI
IC',
i=,
�,
�E
(6
Z
T
c
N
d
�
0
U
�
V
C
N'
�
N
C
I I9 ;
3i
�N
iCl�
�
� I �
Iy
N
d
��
I�I� �
� �
I�
� 1 O
M
�
��
I '
I '
' I
w
IU
�,� '
Im
N'
�
.
m 0
� Q
I Q }
wa
w
' arn
yI
�'�
o,
al
c�
O
N
�I E
0
U
N � .p (�
I O � N O_ d �
I U � i «� N ' C
' V '�6 O N G � � N
� -p M � V ti� d i �
� C � N Q O '
o � �c° U Q � ��
N @���
� y �
� Y� � J Q�
� O� V � � U � m O�
O 3tH�
I w UUt� � � � `� v�o
� - U(0 47 L a1
I Q C N V U V 0 \UUY
i V o°�� m� � mr"-a
� N�� N Q C ?�� U
i� E= w° c�
o�o� o� � 0���
i o���3 0o U d�a�m
.(6p"O OY V V J p_
�� OO�UN N V CYJ � ~ E
�NQ(6 �U ��' �NOO
tD�--Q � (6 ' � � Cll V
o�� ao ��
c v
UOU N C N"6 "6= m�LL'O
o°om� mu � U��v�i
�' z �i-u. X- d� nc c mc �
� d �� . �a� a � a�� �a
� o� mU � � � o �rn
I � � � �mO O�
, O CNN� ON �'j�� Q N
� M' ��N f�
! o Eoo��nooa�cbw�<»�o
0�_��4
OENVRON:�IE�TALEPROT[CTIO;7SAND Ot�1�0
l
Rogcr G««s, Drreclor
CITY OF SAINT PAUL
Namt Colenrnq .11m'or
Case #
BORGSTROM PHARMACY
990 PAYNE AVE
ST PAUL, MN 55101-3902
License Type: License #
CigarettelTobacco 0016685
LOII'RYPROFESSIOn.iL 8L'ILD1.4'G Telrphane: GS/-1GG-9090
350 St Peter S+rcet, Sxite 300 Fuaimrlr: 6.i1-?6G-9/?4
SnintPnul.dlirsioesatn5=10?-/S/0 I(Yb: �nnr.tis�pnuLnuo.us'li�p
Tobacco Compliance Check Purchase Form
� For O�ce Use Only
Compliance Check [.D.n
6usinais i.D. °
Pre Ordinar.ce
_ Post Ordinance
Business Type:
� Concenience � Convenience / Gas � Gas f-�'Dcug Store / Pham�acy � Tobacco / Smoke Shop
!
� Supern�arket / Grocery � General Merchani � Liquor Store / Bar Restaurant � Ol11ef �priratc dub, bowiing, a:c )
Q� �� � o � � : C] �
Date• Time: ( a.m. / .m
M M D D
\�'as p rchase attempted?
�-]'-}'Ces �Na
l
Bu�er � � �
Use 3 initials
�
IS
6
17
R'a sale ntade?
Yes or ho
��
If NO, cIieck rcason:
� Does not sell tobacco � Unsatisfactory/unsafe conditions
� Out of business � Other
� After business ltoucs � Not applicable
Sex Adult ��� Did adult or offcer ��ie�c Vansaction'.
Fe ale Use 3 initials Yes or I�'o
Ma]
R'as age as ' R'as ID requestcd' ��'as ID slion '
Yes or � Yes or �o '_ Yes or No _
Tppe oC purchase:
� elf Service
Clerk assisted
Vendine �nachine - Unlocked
Location of machine
_Vending machine - Locked
Location of machine /
Clerk Information: � ,� Fema4e � Male
T�'p of product: Amount spent: S❑�
_C�garettes �1/fR�-t�Oh �.�
_Smokeiess �
_Other (cigarette papzrs, li�htzr,
Civil Penalty S
Limnser. Ci�il Pznalry 5
Far Offce Ose Only
Appruximate Age: � Under 18
Criminal Penalty S
Suspension:_10 days or Izss
_3? d��5 to ! itar
� u
r �
Actual age if knov�n ���u'�t/�
� and
ii O�er
I 1 to 3l da�•s
_O�er : year
o►-s�'!
I�Tame.of
�.4��/li.c� U��
--� �� ���
Date ofBirth
��a� /�'Z�k' � wl
���R�- /�lt'�,��
Address:
'V �iY�'9L `1
����
���h°s'�>3-j
Driver's License # or State I. D.#:
G 5�ti� � �� ,
; � ��� �-
L �� '
License Group Comments Text
02/28/200'I
Licensee: pETER AMUNDSON
�BA� BORGSTROM PHARMACY �t '� g1
License #: 0016685
OZ/28/2001 To CAO for adverse action., CAR
02/27l2001 Failed tobacco"compliance eheck. Second faiiuire -$400 matrix penalty. Clerk was Rebecca Grimes, 723 York 55106 CAR
08/03/2000 Passed tobacco wmpliance check. SS � -� _. ' _ � . - ' �
07/28/9g passed tobacco compliance check - 08/16/99 letter sent SS
6-17-99—Upgrade Originai Container to Grocery-C License per Environmental Health—Ik
Insp Change From Ot To 02 On 3/20/92 6/5l97 - Sent Cig. Fine Letter (Due 6/27/97) - Lab 6/25l97 - Paid 5200.00 Cigarette Fine - Lab 5/28/97 C.F.
#97-G53 App'D Imposing 5200 Fine For The Sale Of Cigs To A Minor
07l28/99 passed cig compliance check - 08/11/99 Ietter sent SS
o�_��[
�_ _
s Sta�4 .6rou C+�J�se ^�; �ECt �.�`EG��F�e�,e„h...� �erue�Que.�+� � , � �- : ,��'i � �p ��t. '� 1027A63
�... :� P� �.-; �,...,�„� , .,.�.,. s,t v�� ,� � z`��+�2€3%.���.��
..�,�L.�' ..a- .. _
o�.��'1
Addre
Typt
SYre
SYre °
SYre
Dire�:
_ ;
Unit ;
Cdy�
!
s
S
t
r—:
�
�:�+ ��� . *�"�' �.'�'j; Lice�ee ETER RtJiUNOSON
?ay Pnm , A�sc� �t4st� ,�Su�w%�; DBA ORGSTROM PHARMACY
License � Licensee � Lic. Types � Insurance � Bond , Requiremerrts)
� Property �' Licensee C� Unofficisl Project Facildator. ASUNCION, CORINNE ��",'�
Sfreet #: 90 Adverse A ction Commer25
SYreet Name: AYNE '
.. . .___ ,,,.._._____�...____ ___..:
SYreet Type: AYE Diredion: ��
UnR Ind: � UnR #: �! - -
City. T PAUL License Group Commerrts:
State: u1N - Zip: � 55101, 2n8n001 Failed tohacco compliance check. First
� ailure since 1997 -$200 matrix penatty. Clerk was
Ward: ebecca Grimes, 723 York 55106 CAR
Dist Council: �5 8J0372000 Passed tobacco compfiance check. SS
-- 7fZ8P39 passed tobacco compliance check - 08t16I99
Licensee: ETER AMUNDSON l Licensee
�__.. ...__.___... _.._......._._..._...
DBA: ORGSTROM PHARMACY i Commerrts�
Sales Tax Itl: 430-0OS Bus Phone: 651) 771-8807 :`
Lice��: Licens�gTgpe:?.�5'�
1432<j False Alarms �
Alarm Permit (Ren
'1668°i Original Corrtainer
�! License # 6685
12F3il2000
UtilUyfl`Jy8 ; 06109R001 N $10.00
0'I t28M 997 � 03f312000 _ N ] $50.00
Save Changes to History
1027
o�-��t
TypE ?9':R�-���m `�; l' i F�� �% ,� Licensee ETERAMUNDSON
'� j DBA ORGSTROMPHARMACY
Stre
Stre � License Licensee � Lic. Types � I�urance � Hond l ftequiremeMS �
aA-�:._._.:.n.,'� -.
SYre � Licensee Name: ETER AMUNDSON ,:��•�� �t.
=.7z _ � :u:..."z'f L
Dire� DBA: ORGSTROM PHARMACY
Unit ' , p: � �Pi�o e tj s:s�'z �
: Sales Tax Id: 430405 ; Non-Profd: � Worker's Com ONON000
� AA Contract Rec'd: ONOr0000 _, AA Training Rec'd: OIOON000
CRy
, AA fee CoVlected: ONOND00 _ Discourrt ftec'd: �
= Other Agency Lic enses Financiai Hold Reasons
' QliSer Li4 t�*� ;m:..9.e.. eJ1PXd�..," , �1��� i � : � �` �.�� �so_ ,.. :��-'� `, ,,,y ' �f ° �c�.� „ ut� § ���ve�',°_ . ���' �:�:
� � �
�Mail License Ta: —
� Mail To CorRact
�' License Address
1668
Background Check Requiretl r
x��: ����
�Mail Invoice To: —
�` Mail To Co�ad i
�' License Address �
License #
Save Changes to History r
'`�' �
1027AM
Council File # p ��'3 j'y
Green Sheet # � p O G 3.S
Presented By
Referred To
Committee: Date
RESOLVED, that the licensee, Peter Amundson, d/b/a Borgstrom Pharmacy (License ID
No. 16685), located at 990 Payne Avenue in Saint Paul is hereby ordered to pay a fine of
$200.00 for the violation of the sale of tobacco or tobacco products to a minor.
Said fine shall be paid to the Office of License, Inspections and Environmental Protection
within thirty (30) days of the adoption of this resolution by the Council and signature by the
Mayor.
This resolution and the acrion of the Council in this matter are based upon the facts
contained in the Notice of Violarion letter to the licensee and the Tobacco Compliance Check
Purchase Form. The facts were not contested by the licensee.
Requested by Department of:
Adopted by Council : Date � �, �j(' �-OC� \
Adoption Certified by Council Secretary
By: ItiltGCC�. � � so
Form Approved by City Atto
BY. ✓ /
Approved by Mayor for Submission to
Council
BY � o \ � _ _ '1� .-�
��� g � By :
Approved by Mayor: Date /� 6E�
sy:
6
RESOLUTION
CITY OF SAINT PAUL, NIINNESOTA
�A
coun��i
�
io, Zooi I GREEN.SHEET
o l -38q
No1uu�35
)er noscrom Ucf.��rowgro. Varrm.c�—
AG@aA BY (��
AEi1fiN
��OL � Ci n ent IOAWBIFdt ❑CIIYAiIOAEY fJ1YClH11[
�
� a�,�.� .�.,�
❑ r�v°rtfae�amn"p ❑
TOTAL � OF SIGNATURE PAGES (CLIP ALL LOCATIONS FOR SIGNATUR�
Reco�ending that the licensee,. Peter Amundson, dba Borgstrom Pharmacy, 990 Payne Avenue
pay a fine of $200.00 for the violation of the sale of tobacco or tobacco products to'a
minor.
PLANNING CAMMISSION
CIB COMMITTEE
CIVIL SERVICE COMMISSION
OFTRANSACTION
SOURCE
rms uie a��� eve.xa�d unae. a cardrad rarenis depaemenn
YES NO
Hm Mia pnawJfirm aver heen a WY �DbY��
rES rio
Does thie ce�� a� a s16N rat iarma�No�aseaseC DY anY arte�d cnv emdovee4
YE4 HO
b thic pe�aoNfxm a targeted �eiMol7
VES NO
ilein aP vecarrewe�s on aeoarate sf�ee.t end atlech to arcen si�eet .
cosrmEVO+uE auocterm lq�tctR ot�7
ACTIVITYNUMBER
YES NO
�
01-��`y
UNCONTESTED LICENSE MATTER
Licensee Name:
Address:
Council Hearing Date
Peter Amundson, d/b/a Borgstrom
Pharmacy
990 Payne Avenue
Wednesday, April 18, 2001
Violation: Sale of Cigarettes to a Minor
Minn. Stat. § 609.685
St. Paul Legislative Code § 324.07
Date of Violation:
Place:
Presumptive Penalty:
February 27, 2001
Licensed Premises
$200.00 Fine
Recommendation of Assistant City Attorney on behalf of client, Office
of License, Inspections and Environmental Protection:
$200.00 fine (first offense)
Attachments:
1. Proposed resolution
2. Notice of Violation
3. License Information Report
4. Tobacco Compliance Check Purchase Form
5. License information
CITY OF SAINT PAUL
Norm Co[eman, Mayor
Apri13, 2001
Peter Amundson
OFFICE OF THE CITY ATTORNEY
C/ayton M. Robinson, Jc, Ciry Attorney 0`„', �
Civil Division
400CiryHa11 Te(ephone:651266-87l0
ISWutKelloggBlvd. Facsimile:651198-5619
Snin! Paul, Minnesota 55102
NOTICE OF COUNCIL MEETING
Borgstrom Phannacy
990 Payne Avenue
Saint Paul, Minnesota 55101-3902
RE: Cigarette/Tobacco License held by Peter Amundson, d/b/a Borgstrom Pharmacy for the
premises located at 990 Payne Avenue in Saint Paul
License ID #:16685
Dear Mr. Amundson:
Please take notice that this matter has been set on the Consent Agenda for the Council meeting
scheduled far 3:30 p.m., Wednesday, April 18, 2001 in the City Council Chambers, Third
Floor, Saint Paul City Hall and Ramsey County Courthouse.
Enclosed aze copies of the proposed resolution and other documents which will be presented to
the City Council for their consideration. This is an uncontested matter in that the facts contained
in the Notice of Violation concerning the unlawful sale of cigazettes have not been disputed. The
recommendation of the license office will be for a$200.00 fine.
If you have any questions, please call me at 266-8710.
Very truly yours,
���� �����
�
Virginia D. Palmer
Assistant City Attorney
cc: Nancy Anderson, Assistant Council Secretary
� yb a —�fZ;'
�5��;:,_ . �. _�. ..
° �� � � E��ii
�:3 .#
Roger Curtis, Director, LIEP
Christine Rozek, LIEP
Paul Maruska, Community Organizer, Payne Phalen District 5 Planning Council, 1014
Payne Ave., St. Paul, MN 55101
OFFICL �r THE CITY ATTOR��IEY
C[ayton M. Robinsan, Jc, Ciry Anorney Q,�� Y4
CITY OF SAINT PAUL
Narm Coleman, Nf¢yor
Mazch 5, 2001
Peter Amundson
civit Division
400 City Hnl!
1 S West Ke11og; Blyd.
Saint Pauf, hlinnesotn 55/0?
NOTICE OF VIOLATION
Borgstrom Pharmacy
990 Payne Avenue
Saint Paul, Minnesota 55101-3902
Telepkone: 651166-8710
Facsinaile: 651298-5619
RE: Cigarette/Tobacco License held by Peter Amundson, d/b/a Borgstrom Pharmacy for the
premises located at 990 Payne Avenue in Saint Paul
License ID #:16685
Dear Mr. Amundson:
The Office of License Inspections and Environmental Protection has recommended
adverse action against the cigazette/tobacco license held by Peter Amundson, d/b/a Borgstrom
Phannacy for the premises located at 990 Payne Avenue in Saint Paul. The basis for the
recommendation is as follows:
On February 27, 2001, a tobacco compliance checic was
conducted at Borgstrom Pharmacy located at 990 Pa}ve
Avenue in Saint Paul. A 16-year old male entered the store and
was able to purchase a package of Marlboro Lights without
being asked for identification. Sale of tobacco to an underage
person is a violation of Minn. Stat. §609.85 and Saint Paul
Legislative Code §324.07
Since this is a first violation, the licensing office will recommend a$200.00 fine.
At this time you have three options on how to proceed:
If you do not dispute the above facts and do not wish to have a public hearing, you will
need to pay the recommended fine for this violation. If this is your choice, you should
make payment directly to the Office of License, Inspections and Environmental
Protection, Room 300 Lowry Professional Building, 350 Saint Peter Street, Saint Paul,
Minnesota 55102. The letter should be directed to Ms. Christine Rozek. Payment of the
fine will be considered to be a waiver of the hearing to which you aze entitled.
Page 2
Peter Amundson
March 5, 2001
o�-�r1
2. Altematively, if you do not dispute the above facts, but wish to have a public hearin�
before the Saint Paul City Council, you will need to send me a letter with a statement
admittin� the violation and requesting a public hearin�. We �vill need to receive your
letter by Thursday, Mazch 15, 2001. The matter will then be scheduled before the City
Council for a public hearing to determine what penalty, if any, to impose. You will have
an opportunity to appear before the Council and make a statement on your own behalf.
3. If you do dispute the above facts, a hearin� will be scheduled before an Administrative
Law Judge. At that hearing both you and the City will be able to appear and present
witnesses, evidence and cross-examine the other's witnesses. The St. Paul City Council
will ultimately decide the case. If this is your choice, please advise my legal assistant,
Peter Pangbom, and we will take the necessary steps to schedule the administrative
hearing. He can be reached at 266-8710.
If we have not heard from you by Thursday, March 15, 2001, we will assume tLat
you do not contest the facts and witl schedule this matter for the St. Paul City Council and
have it placed on the Consent Agenda during which no public discussion is allowed and the
recommended penalty will be imposed.
Please be advised that the clerk who was identified as havin� made the sale on this date is
also being chazged an administrative penalty pursuant to Minn. Stat. §461.12, subd: 3. This is a
separate action from this license matter. If you have any questions, please feel free to contact me
at (651) 266-8710.
Sincerely,
f/ `��V cr__(����
�
Virginia D. Palmer
Assistant City Attorney
cc: Roger Curtis, Director of LIEP
Christine Rozek, Deputy Director of LIEP
Paul Maruska, Community Organizer, Payne Phalen District 5 Plannin� Council, 1014
Payne Ave., St. Paul, MN 55101
0�-7�'4
STATE OF MINNESOTA
COUNTY OF RAMSEY
ss. AFFIDAVIT OF SERVICE BY MAIL
JOANNE G. CLEMENTS, being first duly sworn, deposes and says
that on March 6, 2001, she served the attached NOTICE OF VIOLATION
on the following named person by placing a true and correct copy
thereof in an envelope addressed as follows:
Peter Amundson
Borgstrom Pharmacy
990 Payne Avenue
St. Paul, MN. 55101
(which is the last known address of said person) and depositing the
same, with postage prepaid, in the United States mails at St. Paul,
Minnesota.
Subscribed and sworn to before me
this 6 day of March, 2001.
v �_ _ __ .. �,M-:..:..�-�. .
� �=.9`�-� °ETcv � PAirG'B6Rt� >
Notary Public �;��:�t�s 11 CTFtiYFU81JC-R�1iNN.SOTH
�Y �:.,k;�. t4'r:AA.j�,ltSSICN �
'�;°.. -• `' _X.I�aqES JAN. 3?. 2'�1;5 �
- .'s^;m--�:��s�¢^c.�-�es^—se,nm�-n--�i
o�_0�'9
,,�
, �'.
�
o�
;a�
,x,
� W I
p �'I r�n I
C i�
d p '
R J ��
n. ko
�'o
�
0
(].
�
C
O
A
�
L
W
�
d
N
c
V
J
r-,
'y I
��
'��
iNI
I
uQ
N
;�m
i� I�
: a �.,
IF '
!��a�
N :a
�
�U��
'J IN
_Q
e ,s ;
0
v
R !Z
N OJ
U �
J :O
I�
a
�
��
r jQ
I
� �' �y
� IQ
� a
�l O
� �
Q
�
Q
2
d
N �
I I�
m �
z�
�Q i�
m
� j �
O
��
Z
O
�
�
� Z
E �
'�i�
�Z
ICI
I ��W
N H
!d I W
` a
IU'
C
��
iV
I•N i
Igo
i�
I I
I��
,
�i
l Q !
X�
w�
N
C
I�
�
�
Z
U
0
�a
IU
c
I�
��I
i�
�
Z '
; �,,
c�
i oa �
E
o ,
U
U.
C
N,
�ry
Ci
�
��
I �I
�N
� n
i� o 0
L I�
a I w
y
d�r CI
.= I �_
m'��
� �
, x �
1 �° I o
C�J
_I,�
! ',
i
�,
�U
iN,
O
U,
m
N
C
`� Z
mO
Z Q
¢ }
W d
W p
`a�
� I
!NI
'.o
'oi
C
�I
�i
;�
I O �,
UI
I � � �
� o � y Q a �
� I L
I ��� U �7 Y ..�. N ' N
� � O N � 1� Q tn
I � � '� Y N °� �- y
�1 Q � O7 � V � fl. �.�
� '`�- O CV '� N Q O�
,, ' � � ti �� U ����
i , N � � Y O � J � Q �
• �� U� 41 � CJ i m O�
. , ` � L U O �7LH�m
� O UC? � � � � rnLL �o
� ' Q'6 C N V C U � N V V c
'' V o°c� mc�i a� m�°
Eo_��u� 'Q� � y���
y
� Q� � Q � �
O_
� d � N
' � O i O� U� O �� C
�"�03 po U ��a�m
. (pp'OOY V V J
OO�UN �(�j CYJ '~�
� '�N .oV �W' �NOO
�waU $ m -� � cu- �
�'- p°� - o o O� j� i� c� �
NchQ'o- N� N N N C cJ
U o U �'� �a� m=U�oa�i
o�. o'm
z�FLLa a rn�...moy
�.-.-`Ko� fl.��ox��
� O_ � N �'-� O_
O 00i6 ��
N�NN � � � p C�
m�� rn or- w
. O �N�O�ON �'j�� aN
' M`NN��JWI�U7�C�N I�
_ oEoo�sa�ootqmwco�ss�o
�
:�
o.
Q
X
,� W �,
""' N N
fV � C ;O
� IU N
� IJ I�
R M
a m
_'o
r
O
Q
d
�
C
O
.�
�
�
w
C
d
N
C
d
U
J
�
O
�
�
i
��
I� I
�IN
C N
I V >
U
IJ , , i Q
fl.�
I�,
� �U
I��
i u�i '� a�i
U
J I O
_,�
.�o
�
�
Z '
C , C�D
iVl�
J' O
�
I i
N
I ��
W
�
Q
�N Z
}
i"O Q
a
�¢
� O
I ` m �
Q
�
�
_
i :
id',�
Z �
m �
0 O
_m
Z
O
�
— Q
N 7
Z �
Q
� W
a w
_a
�I
U
i�
�
O I iU
C
!N
o io
I
i I
'�I
�p I
d
iW ,
�INj
�1
�
�I �
I I�
N
�
I !
IU I
�I
a
Ui
N
�,
��i
IC'
�
�
W
Z
T
c
�'
Q
O
U
VI
C'
m
3'
�I
�
�
Z
i�
'��n
;O
L i�
a �
NI �
�,n
S'�
3 �
m �
i
0 �
N O
M
7
��
�I
I
I
�
i U ,
C�
�
�'
I NI i
�
I'N '
m �
Z Q
�, Q Z
wa
w°
_a rn
I � � �
� �
O � N Q a (n
U � d � ' C
� ��6 O N � \ � N
I S " M � tJ tfJ d i d
O
�.- O NQO�
�. O U 1� C�ID U � C_
� i � � N � @C � D ��
41 y :0 � J Q�
i N Q.�' V� � U � O�
. O Q Y O 4t H c0
' �a C7 rn mo
i O - V (6 y L LL �
� ' Q'O C N V U U o NCjUs
�', I U ( 6 U N (O h„'N
'� 0. U l4 � C C � W � L
� i � N m O.� �� � ��� U
� � N E = N – N
a � O m
�n E �n o � �
� i c o� o m o� o � � c
' °"�� 0o U n�
, � 'mo � �Y � o �J�
U N
�� � 0� U N l9 p CYJ � L�
i� ', ;� O� U O� .�� C � LL U
� �, D� � O O�
I NMQ'O'—� N� Nd NCU
�, UOU�C �N"O 'D=�.!:LL"6
� �ON� (6 t�n � U ��r�n
': Z CHIL Q Q. N Q�=(60y
' a ��. - ��'oo_ �a�ia���n
i O?OO...QO �U
' O O O(6 O� E m�
, N�NN V N� � C ' � C�
E��� rn o �o�y�
' ° ° r•��o o_N
' C C�N �I�
_' O EOOEA�IJOO[n(DWcOEA—O
o�.��
p�_7Pq
',��
,��
,�,
,a
� 'W ',
� i�;O
co ,�,o
d ' V N
�'_
a I IN
1 `
�
0
a
d
�
c
O
.�
�
�
w
c
d
N
C
N
V
J
N
��.. I
,m
���!
i
Ia�il>
i
�Q
I � i
i p N
���
a�I�m
Cla
V N
..J ' (9
_'LL
� �
o �
� �
� �
Z.
N N
C '(D
U �
J'O
I
I �
��
_Q
'N w
i� }
���
a
I_� �
Q
�
�
_
�d
� �
�
�Z �
iQ �
m �
� O
_ m
Z
�
�
—�
N =
Z �
Q
O W
a w
— a
��
IU
IJ
IO�
�U j
�
� N 'I�
� O
I�
I I
d�
I �
Q �
I
Iw I
Ni
�I
I
�
�
N
4
I3 �
Z
IU I
� i
�i
Ic'
N'
i
ICI
��
E
m
Z,
T
@,
Q
0
U
�
U
C
N
�,
Iy
C
-
m�
�i
�I
= I
Z
N'�
� O
L �
a lo�
N
N ^
N
C i
7 ',LL�
m �
�,�
X'.O
~ M
V
—'�
�
�
�
I
�
I ;
�:
iN
U'
INi
iy .
i �'
�
m �
I � Q
I Q Z
i }
I W O
i w
_a rn
i
N
CI
.O
�I
C
O
NI
�'
U:
' � � a tA
i � � d
N N (6 fn
�' a. a
i U � ` d � C
' @ m O a� � � O N
' I� -p O� V � Q d
� I � �N � J NQO�
I o ,°�r tAm U ��,.� c_
I � � N �� ����
� � � �
�� m a� so � Q�
�� N �� V� � Y O � O�
I, O D U U� V� �� LL y p
� L m �
�Q"OCNV UV o NC�CJ
' I Uooc� m� ` co �'��
I O N��� Q'm C ��OU
OQ2� �6
�� �� N E(� O �- C � N � U
' C O O N V� O �� C
°_"�03 po U d�a�m
(6 'O O Y U V J L �-
ON�VN N� C`1J �
>�°�V o� ' �=�cLL�
�` �« "O O O �LLLL N �
N(`'J Q'6 - N+' N N N C U
�oU�� y a=o>wu.
o°om� mr�n � V��ai
z�F-tifl- ay Qcco�N`�
���`�oo_ 7a�m'_F»o_
° o' -O O ° o m ' E� mrn
. N� N N� U N� � C � C�
cp �� OD O i� v�
', O C�NQ�ON i� j�0 O_N
M' C�N I�
_. o Eoov��noov�cowcoF»�o
�'
o;
a
;x
N W :
p �ai.N
O
�f � O
d i p N
R I � J M
a �o
0
a
d
�
c
0
.�
E
L
V
c
d
N
C
d
i.l
J
�
O
�
v
�''�
�
I �
�I
I�
IJ¢
� iU
y
i�:�
� T.�
� I�
i�
iC��
i�.�
i U ; (0
J �
;_U
I�
�
E
��,
Z,
I �U �
IJ , O
�
I �NI
��
�,w
i Q
i y �
!� Q
4 0
�
Jrn �
Q
�
�
Q
2
�I �
i�!�
Z �
�
� I�
�
_ m
Z
�
�
NIZ
E�'�
m
ZiQ
O,
a w
_;a
.U)
IC�
' �I
�I
�'O O
i '
��I
m
, a l
x
W
m
I �
�
�,
� i
i �,
C
@
Q
�,
o;
U'
a�
U,
�
N
yi
I�,
�
��
i� ;
�7'
i Z i
� i
Ic
'o 0
IL ��
d �
N �
N'�
c �
�',�
m�
'O �
F o
M
— �
I
�
iyl
iR�
I
iCi
O
N I
m
N '
C'
,tN Z
m �
Z Q
' 'Q >
�w a
� ;W �°,
i—a rn
I
,
I � � � �
I � � N N t6 f�
o � a a
.� Y � � C
ro (6 O N � � � N
�r W' �
I I O �M � U tn Q� �
C � N Q p �
� � �� �� U ���rn
d R��rn
� � i� � JrQ�
I �'I N �� V� y U � O�
�' �VUL� Uy U �LLtpO
��,p _om �t rn�
Q"OCNV UV ° NUU
I '' � ° o_� m� � c c �a'Or
� yN=d O-� ���U
�I � O U � O ���C
°-'">�3 0 o U ��a�m
'I (p p'a 0 Y V V J L �-
� ON�UN ( V CYJ � ~ E
� > i.n ��U p m .°-�� c cii c
�, O`_'Ow -� � O�LLLL N�
��Q'6� N+' NN NCU
� U�U N � N'� "O= �."-.LL'O
O N i6 N N
� Z �Fti fl- d w rn�°U `mo o,
�.-� L� m nc � o��m
Q n � a� � o.
° 0�9 ° oomV ° orn E o�rn
N NN NOl � C �m
' �c0�� � OI�
; ' OCN\��ON �
c")" C�N �1�
�_ O�OOfAl1�00lQtDWCOER—O
oi-sY1
�, .
�.
��
;n;
� ' I
�.. N i,
� ICi�
� ; � I o
d i C) N
l�6 �� IM
d I ;M
_o
�
C
�
c
O
R
�
L
W
C
N
N
C
d
U
J
�
O
a
v
N I
I�
jN,
j� ''
N d
I � U
� �
U �
�I� jU
- � N
iyi�
d �
�F �O
� !U
c;m
�,:�
IV ;p�
I J'O
a '
E
3,
IZ ,
N'�
N �
IUI�
J O
r1
�I
i�
I,�I�
� —,w
� I�
iQ
��IZ
i}
I� �
� ia
,¢ lo 0
rn�
�� �
Q
�
�
Q
_
a
i���
�'��
Z ��
�a :�
� ;�
i�
_ m
Z
O
�
N
E',�
m.�
Z'
G , Q .
0
W
a,a
�C ,
i
ID
I V I
IVI
I � N I�
I� o
�
'�
i
Q i
iW �
I�i
I��
�
i '?1
�Z I
IU'
a'
iV
C
,m�
INI
IC',
i=,
�,
�E
(6
Z
T
c
N
d
�
0
U
�
V
C
N'
�
N
C
I I9 ;
3i
�N
iCl�
�
� I �
Iy
N
d
��
I�I� �
� �
I�
� 1 O
M
�
��
I '
I '
' I
w
IU
�,� '
Im
N'
�
.
m 0
� Q
I Q }
wa
w
' arn
yI
�'�
o,
al
c�
O
N
�I E
0
U
N � .p (�
I O � N O_ d �
I U � i «� N ' C
' V '�6 O N G � � N
� -p M � V ti� d i �
� C � N Q O '
o � �c° U Q � ��
N @���
� y �
� Y� � J Q�
� O� V � � U � m O�
O 3tH�
I w UUt� � � � `� v�o
� - U(0 47 L a1
I Q C N V U V 0 \UUY
i V o°�� m� � mr"-a
� N�� N Q C ?�� U
i� E= w° c�
o�o� o� � 0���
i o���3 0o U d�a�m
.(6p"O OY V V J p_
�� OO�UN N V CYJ � ~ E
�NQ(6 �U ��' �NOO
tD�--Q � (6 ' � � Cll V
o�� ao ��
c v
UOU N C N"6 "6= m�LL'O
o°om� mu � U��v�i
�' z �i-u. X- d� nc c mc �
� d �� . �a� a � a�� �a
� o� mU � � � o �rn
I � � � �mO O�
, O CNN� ON �'j�� Q N
� M' ��N f�
! o Eoo��nooa�cbw�<»�o
0�_��4
OENVRON:�IE�TALEPROT[CTIO;7SAND Ot�1�0
l
Rogcr G««s, Drreclor
CITY OF SAINT PAUL
Namt Colenrnq .11m'or
Case #
BORGSTROM PHARMACY
990 PAYNE AVE
ST PAUL, MN 55101-3902
License Type: License #
CigarettelTobacco 0016685
LOII'RYPROFESSIOn.iL 8L'ILD1.4'G Telrphane: GS/-1GG-9090
350 St Peter S+rcet, Sxite 300 Fuaimrlr: 6.i1-?6G-9/?4
SnintPnul.dlirsioesatn5=10?-/S/0 I(Yb: �nnr.tis�pnuLnuo.us'li�p
Tobacco Compliance Check Purchase Form
� For O�ce Use Only
Compliance Check [.D.n
6usinais i.D. °
Pre Ordinar.ce
_ Post Ordinance
Business Type:
� Concenience � Convenience / Gas � Gas f-�'Dcug Store / Pham�acy � Tobacco / Smoke Shop
!
� Supern�arket / Grocery � General Merchani � Liquor Store / Bar Restaurant � Ol11ef �priratc dub, bowiing, a:c )
Q� �� � o � � : C] �
Date• Time: ( a.m. / .m
M M D D
\�'as p rchase attempted?
�-]'-}'Ces �Na
l
Bu�er � � �
Use 3 initials
�
IS
6
17
R'a sale ntade?
Yes or ho
��
If NO, cIieck rcason:
� Does not sell tobacco � Unsatisfactory/unsafe conditions
� Out of business � Other
� After business ltoucs � Not applicable
Sex Adult ��� Did adult or offcer ��ie�c Vansaction'.
Fe ale Use 3 initials Yes or I�'o
Ma]
R'as age as ' R'as ID requestcd' ��'as ID slion '
Yes or � Yes or �o '_ Yes or No _
Tppe oC purchase:
� elf Service
Clerk assisted
Vendine �nachine - Unlocked
Location of machine
_Vending machine - Locked
Location of machine /
Clerk Information: � ,� Fema4e � Male
T�'p of product: Amount spent: S❑�
_C�garettes �1/fR�-t�Oh �.�
_Smokeiess �
_Other (cigarette papzrs, li�htzr,
Civil Penalty S
Limnser. Ci�il Pznalry 5
Far Offce Ose Only
Appruximate Age: � Under 18
Criminal Penalty S
Suspension:_10 days or Izss
_3? d��5 to ! itar
� u
r �
Actual age if knov�n ���u'�t/�
� and
ii O�er
I 1 to 3l da�•s
_O�er : year
o►-s�'!
I�Tame.of
�.4��/li.c� U��
--� �� ���
Date ofBirth
��a� /�'Z�k' � wl
���R�- /�lt'�,��
Address:
'V �iY�'9L `1
����
���h°s'�>3-j
Driver's License # or State I. D.#:
G 5�ti� � �� ,
; � ��� �-
L �� '
License Group Comments Text
02/28/200'I
Licensee: pETER AMUNDSON
�BA� BORGSTROM PHARMACY �t '� g1
License #: 0016685
OZ/28/2001 To CAO for adverse action., CAR
02/27l2001 Failed tobacco"compliance eheck. Second faiiuire -$400 matrix penalty. Clerk was Rebecca Grimes, 723 York 55106 CAR
08/03/2000 Passed tobacco wmpliance check. SS � -� _. ' _ � . - ' �
07/28/9g passed tobacco compliance check - 08/16/99 letter sent SS
6-17-99—Upgrade Originai Container to Grocery-C License per Environmental Health—Ik
Insp Change From Ot To 02 On 3/20/92 6/5l97 - Sent Cig. Fine Letter (Due 6/27/97) - Lab 6/25l97 - Paid 5200.00 Cigarette Fine - Lab 5/28/97 C.F.
#97-G53 App'D Imposing 5200 Fine For The Sale Of Cigs To A Minor
07l28/99 passed cig compliance check - 08/11/99 Ietter sent SS
o�_��[
�_ _
s Sta�4 .6rou C+�J�se ^�; �ECt �.�`EG��F�e�,e„h...� �erue�Que.�+� � , � �- : ,��'i � �p ��t. '� 1027A63
�... :� P� �.-; �,...,�„� , .,.�.,. s,t v�� ,� � z`��+�2€3%.���.��
..�,�L.�' ..a- .. _
o�.��'1
Addre
Typt
SYre
SYre °
SYre
Dire�:
_ ;
Unit ;
Cdy�
!
s
S
t
r—:
�
�:�+ ��� . *�"�' �.'�'j; Lice�ee ETER RtJiUNOSON
?ay Pnm , A�sc� �t4st� ,�Su�w%�; DBA ORGSTROM PHARMACY
License � Licensee � Lic. Types � Insurance � Bond , Requiremerrts)
� Property �' Licensee C� Unofficisl Project Facildator. ASUNCION, CORINNE ��",'�
Sfreet #: 90 Adverse A ction Commer25
SYreet Name: AYNE '
.. . .___ ,,,.._._____�...____ ___..:
SYreet Type: AYE Diredion: ��
UnR Ind: � UnR #: �! - -
City. T PAUL License Group Commerrts:
State: u1N - Zip: � 55101, 2n8n001 Failed tohacco compliance check. First
� ailure since 1997 -$200 matrix penatty. Clerk was
Ward: ebecca Grimes, 723 York 55106 CAR
Dist Council: �5 8J0372000 Passed tobacco compfiance check. SS
-- 7fZ8P39 passed tobacco compliance check - 08t16I99
Licensee: ETER AMUNDSON l Licensee
�__.. ...__.___... _.._......._._..._...
DBA: ORGSTROM PHARMACY i Commerrts�
Sales Tax Itl: 430-0OS Bus Phone: 651) 771-8807 :`
Lice��: Licens�gTgpe:?.�5'�
1432<j False Alarms �
Alarm Permit (Ren
'1668°i Original Corrtainer
�! License # 6685
12F3il2000
UtilUyfl`Jy8 ; 06109R001 N $10.00
0'I t28M 997 � 03f312000 _ N ] $50.00
Save Changes to History
1027
o�-��t
TypE ?9':R�-���m `�; l' i F�� �% ,� Licensee ETERAMUNDSON
'� j DBA ORGSTROMPHARMACY
Stre
Stre � License Licensee � Lic. Types � I�urance � Hond l ftequiremeMS �
aA-�:._._.:.n.,'� -.
SYre � Licensee Name: ETER AMUNDSON ,:��•�� �t.
=.7z _ � :u:..."z'f L
Dire� DBA: ORGSTROM PHARMACY
Unit ' , p: � �Pi�o e tj s:s�'z �
: Sales Tax Id: 430405 ; Non-Profd: � Worker's Com ONON000
� AA Contract Rec'd: ONOr0000 _, AA Training Rec'd: OIOON000
CRy
, AA fee CoVlected: ONOND00 _ Discourrt ftec'd: �
= Other Agency Lic enses Financiai Hold Reasons
' QliSer Li4 t�*� ;m:..9.e.. eJ1PXd�..," , �1��� i � : � �` �.�� �so_ ,.. :��-'� `, ,,,y ' �f ° �c�.� „ ut� § ���ve�',°_ . ���' �:�:
� � �
�Mail License Ta: —
� Mail To CorRact
�' License Address
1668
Background Check Requiretl r
x��: ����
�Mail Invoice To: —
�` Mail To Co�ad i
�' License Address �
License #
Save Changes to History r
'`�' �
1027AM