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2 jpg3/12/2018 <br />8. <br />8. <br />OR <br />10. <br />13.Names of responsible <br />"Important" <br />14.Completed <br />Signature <br />Tap FJEHT A°c <br />VIhttps://maH.google.com/mail/ca/u/0/#inbox/1604e532ac032677?projector=l&niessagePartld=0.5 <br />A- <br />Titte <br />EHD 16-C-2 <br />1X-3AW <br />GartMKja <br />Can <br />| Cix-gaetra | <br />Rrcaax Ssxit | _ <br />Sj* :ri-twc-<i I <br />L-^cfc/.a^rrfC I <br />=,i->i»artr)ic.ceii I <br />— ---- <br />Sooth must be on <br />Concrate.Asphal. <br />Ptywnod, or a Tup. <br />Health Permit k <br /> Water supply dispenser with warm water at a minimum of 100'F (Le. 5-20 gallon container wth spigot) <br /> One separate tub (txKtet or barsin) for the coileoioo of rinseArastewater <br />"J**1 tD intW«ifrL Pta-o mte» a copy of Ms mfaHfon m <br />Date <br />I Prop-ic Ttsei <br />®tas»wO-.«n3 <br /> Ice chests Refrigerator <br />^Refrigerated truck f~~: Ice both and tubs <br /> Other (speciiy)_ <br />_, V[ fic»e^:;’.7rr I ____ \ <br />/ || | iwWMr [| [ UmeiraT] | | <br />At <br />lceCoolei ‘ h ____-'/ <br />..........• <br />I am providing the following items within my booth for the sanitary cleaning of food praparalton utensils: <br />fi^Three compartment sink <br />S^^w^.onhfortetengtmdoneforatteach <br /> Detergent, bleach, and wiping dolhs (cleaning towels) <br /> Tub to store wiping cioths in bleach solution <br />UmpoWdmg the following for adequate hand watering fac-Wes. but separate Item utensil vrash within my