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10. <br />II. <br />OR <br />12. <br />13. <br />“important*' <br />14.natureS <br />I k <br />■ <> <br />. ti <br />•A.*’**' <br />.Jit l.«I <br />V.-., ■ <br />f;*o; l-.ron C;'’'’ <br />r <br />X09 •l(Mi ■<420 | I- <br />n <' ’ i <br />('illlliKII- <br />Cait <br />J lee Cooler <br />I <br />SAN JOAQUIN <br />< • > I I ' ; I r <br />.... <br />Title <br />| | loalth Permit ) ’ <br />H. a h R l"' <br />Lt <br />.....—..........: <br />weeks.prior, to. <br />75/^3 <br />Date / <br />Bo.il’i iiu -4 !>«■ o'1 <br />I Kl. ■' I <br />e. 5-2.0 gallon container with sp'O^O <br />..... Ik- <br /><<■<’!)!• | T <br />•*. »t’p ' <br />of food preparation Utensil <br />5 <br />16 <br />I am providing <br />booth <br />M W3te sunpty dispenser wiih wnnn wnier »< a n-i.nrnn of ICO f- V <br />^Onesopa^fpOOK-orbnsi.....or ff.o eo^iion of rios^rsf^™. <br />I up.apor towels and pump-s.tyte S<W ™’,ainor- <br />Names Of rnsponsibl.: persons 101»WO*- - ' <br />All food■■va’xtaixjoths wo S I" <br />this_cvcnt.. > Ar*Jin^Y <br />Completed by. <br />y.r- 404 ni.’.m ■ '^wai'jehd^rn ah. <br />Environmental Health Department <br />...'.j/l'f.' <br />IBHBI I lu/rltcn Av.-nii.-| ■ <br />1 •iti :r. o> <br />11/r.vt.' <br />I .. fl Z. ‘ '» <br />' I <br />j ; .. .] in I ■.'. 1 <br />(JCJU <br />\ <br />\ <br />( | [ ip,. 1. u .1 >1 W'd'l <br />1 ‘k^fSl ' <br />, . M3 Refrigerator <br />1 "COC,WS'S „ „ | | ICO bath and lobs <br />| | Refrigerated truck 1 <br />| | Other (specify).------ ------------------------------ ----------- <br />the fo^no items wilt....... booth for the snni,my den.... . <br />^•1 hroe compadmont sink. f()f 11|e{lch <br />, | niroe dnop tubs ,Or 5“Py *' " ' <br />I‘t1o"Xn'wXmd wtpintt cloihs (cleaning towels). <br />...—............................. ...........................