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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. JOi COUNTY <br />pE PA R�M'Inspection Report Fax: 574-235-9497 <br />TMEN h�0 ��:A LTF[ <br />Based on an inspection this day, the item(s) noted below identify violations of 410 IAC 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 />, <br />. - r.,- L . - r . ;r. ; <br />( ) Establishment <br />- ,.• u ^ — �' <br />{,j Owner <br />Inspection <br />(mm/dd/yr) <br />Establishment Address (number and street, city, ZIP code) <br />Purpose:O <br />- 'off- <br />y <br />Follow'Up <br />Release Date <br />Ownerf <br />1. Routine <br />- <br />t <br />2. Follow-up <br />- <br />v� <br />Owner's Address - <br />3. Complaint <br />Summary of Violations <br />4.. Pre -Operational <br />. <br />5. Temporary <br />C NC U R <br />_ <br />Person In Charge <br />6. HACCP <br />7. Other (list) <br />Menu Type <br />f <br />1-2 `/3-4_5� <br />Responsible Person Email <br />-� <br />i •r r - '� <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 # C/NC R Narrative To Be Corrected By <br />Received by (name and title printed) I Inspected By (name and title) — <br />II` <br />Received by (signature)~� - �� Ias�e�ted�By (signature). <br />- r �r-9«-� • '` Lam- �i f � - �- 'i <br />f•' F age`I Of <br />