Laserfiche WebLink
Environmental Health Department <br />10 <br />11 <br />OR <br />12 <br />13. <br />“Important" <br />14. <br />Signature <br />M>wiv>'vSfd <br />c,tr>, «* <br />Cvi <br />•mm <br />Gencitie. Aipaat <br />Ptywas, er s rBn <br />□ Water iuppfy (JhoenMH with wflrm wftl0. a( „ ntni(r4jrn 1WrF (1 c 5 20 <br />I..) One aepwnfc tub (bucket or Imln) for tho ccteotion of rnsp/wBStawaler. <br />[ I Pnper tpwefa ihhi omno-rivte aoeo conlMnor <br />Rar*y H?8?311^40 por*ona to be P*eoan« n bodh taring M boms erf operation <br />r«»j a rmft <br />I e n Ac * U* Bl <br />te' - r“—“a - <br />L_J Oelcrgent, bleacr., and wsp-ng tkrths (cfeenino Ic/At-ls) <br />I | Tub to store wiping dclhs in tiiesc h sd.rfjon <br />I «n u,. hm, fc, haM bul (ram w]j <br />SAN JOAQUIN <br />- COU N’l Y <br />>'- <>«TtH..r •.% yrju*' liitt, <br />(J Ice cherts [7] Refr'gerator <br />□ Refriffeteted truck p |CO bfl1h onfl <br />O Olnor 'speofy) ‘■'lexer <br />Al food vondor bcothu are sut^t to inspection Plea*, mnM » cct.y of this applcauon’r <br />proparoton 'ey m-s oven!. A copy of th<5 checklist must be in the Imft o.SZ±" BS^W ftcfaMWl td fWti/rt Cooirfmalrwr-IMonn ■fi.nrtor to <br />Coirpioted by___oragnizei ____ j / <br />Title Dale <br />rTyr>~.-:-.-,- ;-yy.- X.y,. <br />Health Pormtt 11 <br />Ice Cooler i <br />I _