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maoo 6487327 JPG <br />Environmental Health Department <br />OR <br />12. <br />Signature <br />Health Permit <br />Ice Cooler <br />Boolh muit be on <br />Concrete. Aiphah <br />Ptywood.or*T«n> <br />14. Completed by: <br />! am proving the (ollowmg tor adequate hand washing Uokbes. but <br />One separate tub (bucket or bas.n) tor the coUection nt nn^astewaler. <br />f/l Paper towels and BumfcSt¥ia.SQac container. <br />,3. -------------------------- <br />------------Z7L rj,l«nia 9S20SI T 20S46S-3420I F 20S 46441138 I <br />1868 E Hazelton Avenue | Stockton. C p^eortt <br />EHD iMZ <br />06119119 <br />• SMblOAQUlN <br />—COUNTY------ <br />. r-Grrotn/iv orowi here <br />10 lam providing the foil owing cold temperature control for the cold holding ol potentially hazardous foods below <br />45T (rf food is used the following day. maintain below 41'F temperature). <br />[i] tee chests O Refrigerator <br /> Refngerated truck Ice bath and tubs <br />O Other (specify).------------------- -- --------------- ---------- ----------------------