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<br />L-5~...47Cj!;':
<br />
<br />R, E' S""~ 'D' r= 'N' ;
<br />t,. I ~..
<br />
<br />~AL GROUP
<br />
<br />C. A' '.!"""<'. "'. -. "'..
<br />rA '~'~ ~'L
<br />. ,n~
<br />~ ~&.:~
<br />
<br />
<br />~r...
<br />
<br />
<br />JRPOSE:
<br />IiIie ROUTn~E
<br />= CONSTRUCT,
<br />=
<br />=
<br />
<br />
<br />" ST1\lT~~",;J')j~JUJi)-AF. .
<br />'pEPARTME~1()JtIIE4\L1'~ i
<br />COUNTY HEALTH DEPARTMENT
<br />RESIDENTIALGROUP'GARE
<br />INSPE'CTION'REP()R.T
<br />
<br />............
<br />...._, -- ...-
<br />
<br />
<br />
<br />........................................ ........~...........-......,........-.....
<br />..>;-:,_.... ",
<br />
<br />
<br />.'" ,.
<br />- '-, .'. ...; ~
<br />,....,.,. ." ."-"."
<br />-.' ~ . &"1:.9" ..-'___ -'. ~:-
<br />
<br />= REINSPECTION'
<br />= CHANGE OF OWNER
<br />= CONSULTATION
<br />= 'EPIDEMIOLOGY
<br />o HER
<br />
<br />WATER SUPPLY-' J(~'
<br />= J., Approve~ system~. .',
<br />= 2, Operation
<br />
<br />= 14, Warewashing/Cleaning = 26, DO NOT USE
<br />= 15, DO NOT USE = 27. InfestationIPresence
<br />
<br />= J::BacteriologicallChefuical = 16, FoodOther~' =. 2S,Stfeening
<br />
<br />= 4, DO NOT USE
<br />
<br />HOUSING
<br />
<br />BEDDING, TOWELS,
<br />& PERSONAL ITEMS
<br />
<br />. e:::::J'36,St6fa:gelLocked
<br />GARBAGE/RUBBISH
<br />= 37, Collection
<br />.' =3S:Storage/Container
<br />c:r 39,Disposal
<br />
<br />= 45, Other
<br />= 46, Other
<br />e:::::Je 47. Other
<br />= 48:0ther
<br />
<br />= 5,Water Accessible
<br />
<br />= ]7, Maintenance
<br />
<br />=".itc'v~mperattife/Silpply'-:' '.'=
<br />FOOD SERVICE 1\ \,l./ };b
<br />
<br />~ ; ::=;;t'~. ..~:
<br />
<br />= 9, Equipment rv"" _ =
<br />= I 0, Holding & Cooking Temps, =
<br />
<br />IS. Construction
<br />19, DO NOTVSE
<br />
<br />= ILDONOTUSE...
<br />= 12, Storage
<br />
<br />20, Cleaning/Odors
<br />21. LightingIFLCand1es
<br />22, Plwnbing
<br />23, Inside Tel11perattire
<br />24, Sanitary Facilities
<br />25. Sewage
<br />
<br />= 29,Beds
<br />= 30,Linetls
<br />= 31. Storage
<br />= 3Z;'Pe.rsonaLSpace.
<br />- "f.AuNDRY
<br />
<br />RECREATIONAL AREA =4~t;9ll}er
<br />=-.40, Safe .=. 50;,Other .
<br />= '4r.Drairied/I;iifl~rlTfash = '51 : Other' .
<br />
<br />=
<br />=
<br />
<br />. = 33. SeparationsJ.rransport: . 6' .42, DO NOT USE.
<br />
<br />= 34, Vented = 43, Water Safety
<br />
<br />52, Other. '
<br />= 53, Other
<br />
<br />ITEM
<br />NUMBE~",
<br />eft
<br />
<br />.~~
<br />
<br />COMNIENTS ANDINSTRUCfioNSc'
<br />(continue on attached set)
<br />
<br />.....~~.".c
<br />
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