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10 <br />/\J A- <br />A (<11 <br />OR <br />b'each <br />12. <br />washing facilities, <br />13. <br /> ^Important' <br />14.Completed by: <br />SignatGre"Date <br />Health Permit <br />Paper Hand Towels <br /> Soap dispenser <br />Cutting Board <br />Propane Stove Bleach <br />7' Z 7/ <br />F <br />ie Jan* <br />Rinse Water Bleach and Water <br />Fire Extinguisher <br />& Cooler <br />Soap and Water <br />Booth must <br />Concrete, I <br />Plywood, o< <br />Exira <br />Water <br />S-20 Gal <br />Hand wash Water <br />Garbage <br />Can <br />Stemo w/Chaffing <br />Dish <br />Sanitizer bucket­ <br />bleach 4 water for <br />storing wiping doth <br />SM joaouin <br />county— <br />Title <br />sanitary cleaning of food preparation utensil <br />□FOther (specify) a I A- ( 1 lce bath and tubs <br />................. <br />□ Paper towels and pump-style soap container. <br />Names^ponsibte persons tobe present in booth during ail hours of operation: <br />Environmental Health Department <br />th^vent rd OPera“On- to <br />my for ,he <br />fer soapy wa,er' °ne ,or =□ rub towU). <br />I arn provWing the fo||owing for <br />but separate from utensil wash witWn mv