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foods bale* <br />ID <br />OR <br />Conip'eted by Title <br />Health Permit <br />fee Cooler <br />1>MP EVtHT APPP«oeaol1iCHD'e-02 <br />08/0V16 <br />Ltr'-',atr <br />We<a<> & wshtr 'or <br />Q Refrigerator <br />Q ice bath and tubs <br />□ lee chests <br />0 Refrigerated truck <br />□ Other (specify) <br />------------------------->600th must be on <br />Concrete Asoha.t <br />P.Yeooo, or a Tarp <br />to. s«W W tor a '’,eaC" <br />Cst>tg« <br />Can <br />3/12/25 <br />Datei <br />Signature <br />Detergent b*ach. and womg clottis (cleaning towels) <br />□ Tub to store wiping doths in bleach solunon <br />a——’Wf ir^W’ <br />gjone w«<»■'“« °' ">*’* ,l,’“toasle”a"f <br />(^Paper towels and gumprstyle container <br />Names of responsible persons to be present in t <br />p<epaiation for this event A copy c n f-<tiua, rA<,rriinator three weeks pnorto <br />preparaton and operaboo Return <br />tfiis event