HomeMy WebLinkAboutFood Service Establishment Inspection 17 (32) Page of
INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION
` S 1 1
INSPECTION REMARKS
FORM#
0\-QZ
MA
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INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE
Distribution: 1 st-White-Health Department 2nd-Yellow-Owner/Ma ger