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SJCHD Form 04.22.01 <br />St. Joseph County Department of Health <br />Retail Food Establishment Telephone: 574-235-9721 <br />ST. JOSEPH COUNTY Inspection Report Fax: 574-235-9497 <br />DEPARTMENT OF HEALTH <br />Prc ,1. o' _.fro , <br />Based on an inspection this day, the item(s) noted below identify violations of 410 ]LAC 7-24, Indiana Retail food Establishment <br />Sanitation Requirements. The time limit for correction of each violation is specified in the narrative portion of this report. <br />Establishment Name <br />Telephone Number <br />Date of <br />ID # <br />( ) Establishment <br />Inspection <br />_ <br />_ <br />:") Owner�- <br />(innifdor) <br />Establishment Address (number and street, city, ZIP code) r' . <br />- <br />Purpose: <br />- - <br />Follow Up <br />Release Date <br />Owner / <br />1. Routine <br />2. Follow-up <br />s J <br />Owner's Address _ <br />3. Complaint <br />Summary of Violations <br />r4. Pre -Operational <br />5. Temporary <br />_ <br />C 'NC R �-- <br />PersDm In Charge _ <br />�- <br />Menu Type <br />Responsible Person Email <br />7. Other (list) <br />1 2� 3-4 —5 " <br />Certified Food Handler <br />• CRITIAL ITEMS ARE IDENTIFIED IN THE CHECKLIST AND NARRATIVE COLUMNS MARKED "C" <br />• VIOLATIONS REPEATED FROM THE PREVIOUS INSPECTIONS ARE DENOTED IN THE `SUMMARY OF VIOLATIONS" AND IN THE NARRATIVE BELOW AS "R" <br />Section # I C/NC I R I Narrative I To Be Corrected By <br />r� <br />-�-7 - <br />Zf7/ <br />Rage 1 of <br />