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1 PLAN CHECK OFFICIAL INSPECTION REPORT
IIII WHOLESALE INSPECTION
COUNTY OF-LOS ANEGN'vEILRE0SFIDEENPT?t,\ALR14tEAZET,HOF
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1 SECTION I: TYPE OF INSPECTION
i 190-Day Ev
Preliminary Inspection
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i 1 ul Follow Up Inspection
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Revocation Evaluatici
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f2 ..... Final Inspection-NEW
Final Inspection-REMODEL
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SECTION II: STATUdStoO.FpePraEteRpMurITu InLtIoCtEhNe SE
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APPROVED The facility
/establi:.hment is approve
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DENIED:The facility/establishment is NOT approved to operate.To obtain approval,
. 7 the requirements needed are
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lSubmit 3 sets of detailed plans:See Conttruction Requirement Guidelines at www.publichealth lacountv.goviett
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+Obtain local Building&Safety,Fire Department and other agency permits and approvals
SECTION III: LIMITS&RESTRICTIONS
The approved facility/establishment may engage in the processes/activities marked below:
•••• -.,..; *:' s:„.a Ns' '' T-, E Use Multiservice Utensils
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■ ....JIM ''''''. .."- Steck Prepackaged/Non-Potentiaky Hazardous Foods I Serve Alcoholic Beverages ,
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No ->< i Stock Perishable/Potentially Hazardous Foods
i,/,..„,May NOT Serve Alcoholic Beverages For On-Site Consumption
-AU_ "•-,,, ...,,. }X.IFood Preparation Food Demonstration
r Fox!Preparation-UMITED FOOD PREPARATION Wholesale Food Processing
i Or;k4""j (j i ,Food Preparation-NO COOKING PERMITTED 1Food Market Wholesale
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2 _au ----1- - \. , i.,Lo • l i Food Market Retail,Prepackaged Foods Only I !Other:
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E? -11- tcici I. e.1*T SECTION IV: FEES I ADMINISTRATIVE ACTIONS
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A fee in the amount of$ must be paid prior to the next field inspection.
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1CLOSURE Operating without final approval and/or without Public Health Permit OR License
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Administrative Review/Office Hearing has been sChed—uled-on---1---------,ar----a.M.TP.M.-(P7ov-ide Valid Photo Identlficahoin
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4" 0 tt..‘ E. Q• C.,,Z SECTION V: DISCLOSURES
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It is a misdemeanor violation to begin operation without a valid Public Health permit/license.The Public Health permit/license will be
J. ---'. 12.. e.,..g5. issued by the Plan Check Inspector at the lob site following final inspection and approval by all applicable agencies Remodeled areas of
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'al , . ... _. : . ,... ‘.. Any future alteration.construction,building renovation,repair,change of equipment,change of the oPeratien-dia.food fa lit /
i , , , 7 041 !establishment or change of menu may require plans to be submitted to the Health Department Plan Check Program Additional approvals 1
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may be required from other enforcement agencies
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lit is improper and illegal for any County officer,employ ee or inspea.--,-,-,.sbilUitbribehs:gifts or gratuiues in-co- hhectio n with-performmg
their official des Improper solicitations include requests for anything of value such as cash.discounts.free services.paid travel or
County employee to solicit bribes,gifts or gratuities for any
'(-.3 co) )entertainment,or tangible items such as food or beverages.Any attem by t
ix 0) ;reason should be reported immediately to ether the County manager responsible for supervising the employee or the Fraud Hotline at 1
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e (800) 544-6861 or wyvw lacounlvfraudorg YOU MAY REMAIN ANONYMOUS
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_ _ SEE REVERSE SIDE FOR ADDITIONAL CRITERIA --- TO:age-4-4.—..."-' -1
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