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EnvironniPiilal Health Dopartmnnt <br />Hl <br />11 <br />t? <br />iwihle {mem tu <br />l 1 1 r / <br />"Importanr* <br />‘•4,Completed by <br />Smi a v«-i« j <br />14<» <br />ico Cooler <br />I <br />• e» r <br />y ,L i <br />Tlllc <br />S fj* w-r «wi <br />I am providing IM lolkwing cckl b n vi vhim <^4rr.U M IM ersfe! holding ■ 1 '</ -’Si bd<?// <br />•<5*F I if food n uiw?d IN* fon( Winq d^y, rnninbiwn MHr* 4 KF tempnnjfor*) <br />Wlc*'chniU tr} FWrii7«M .wiry <br />O Rnl wrnterf In ir I. 11 W.n Mlb nnd l ubn <br />O Other (aoecdyl . <br />I arn piovtihng lhe billowrg inr tir|rq\uste hand wwJwkj laoWm. but r.nparnte fmm i*teniul wMh 'M-h-t. try <br />boollh <br />II <br />•«»«» <br />n » WWW >-« <br />(>■>^■<.<1 »r« <br />fMh <br />SAN JOAQUIN <br />< OUNTY <br />t «■» <br />*v»>^ <br />HWairw Mtpply dispwinor with warm water at a minimum ol IfXTF (i w *• 20 rontonur w^ti *»(. njuIJ <br />/f 1 fmn ’.epnnfn tub (bucfciM or form} lor the cnlledion cd cintMtfwatitew.ikM <br />towels and pMinp-alylq wp oonlwner <br />Naraw of tot <br />fy^y <br />'^ifcr*4irjc <br />r* <br />»-» :m <br />r tWT* imil .■?»>"> J <br />\-AI ■' <br />fur,-- / , ; cirwn; tn <br /> „ r -....n <br />I fC "A IMVST’ ’*IAI •«’ *• <br />I rt r4>r-«'*rfi* Ai4,r.**t|^ •>• II J'-----J <br />I iVoffn ftMCR A lixrf I •t'sanf’l •» <H t* I3 <br />al l/Oi- I I <br />tr—u tM <br />j bk»«n vil Aum j I | <br />'' 0 <br />_./ <br />Slgnalurc <br />JT77 <br />Ucn-niMM. I1 flrxn ■AW- <br />I mnpruvttUnn ’M tollnwinq tfemi wt!h»n my booth lor Iho tuinfkiry dban^x) M tel nr**p.-tfwli>:yi u«wim| <br />jlrflhirw oompn'tireAl stnM <br />OR^ <br />deep lull* thewnfi !¥-& inr.lwt nunnniirnl one lex aoAfiy wnlr- orw far rmwKj and one f< i i>-*h <br />MjlyJxjn (one labfanpoon of bleach per gallon <>l writer) <br />.k* petergorfl tofaoch. and wiping clothi (deanmg <br />J-^ hih to store wiping clnlhn in Uniwih ficMirm <br />( I tealAh Permit <br />• *.«« >«MM t •"»t ] <br />(yo*.i'iil in bwith rfestfog :v! Iwm of c^inr itejn <br />fijaau—ftA.zX,\<?tC.f\2- .Q----------------------- <br /> <br />AH food vendor booths nrn twb|ecl Io nspreton Ploann mnko a ccc/ of thn w>ot»coliQn <br />pteporolicn for this evnnl A copy of this chn*M$l must bo m the mvu*- al rH noun of <br />preparation and operiitinri Return original to feMlviH coordinator three weeF^, pmc to <br />Jhu^i A A 7— : o.-/V^A <br />Date