[BIS FORM NO. 101 HEALTH CERTIFICATE FOR FOOD HANDLERS. (CREAM COLOR) Office of the City/Municipal Health Officer SANITARY PERMIT TO OPERATE roe — = Issued to. no [oarrornee gitar ey | occu on | sce__se__ naionaury Tar . (ype of Enablichment) FACE OF WORK: bate mo | eenuur Address. 1p SGNATORE CTR SiO. «OTHER BN. ROD. SOSA pate xno [meu Sanitary Permit No. Date Issued 19, xt SEAN CHARGE HOMES, e Lego of Cty SP Oise of techy Mun, Beat Otter Regio. HEALTH CERTIFICATE. erapiotpoosene 0.227038 wd iy) IMPORTANT ansrnsdit® HAUT CRMREATE (HON Ehrich nce women” “ORTONSE YOUR aunvarion as inoeareDeEtoN EF manunZaTioN Date of Expiration December 31, 19, This permitis not transferable and will be revoked for violation of the Sani- tary Rules, Laws or Regulation of P.D. 522 & P.D. 856 and Pertinent Local Ordinances. Re commending Approval: ‘CSD/SE/SSI/SI Approved: CHO/MHO TRONT Gem Fem) HEALTH CERTIFICATE FOR NON-FOOD HANDLERS (LIGHT GREEN COLOR) _ eases | IMPORTANT ys aEoy ee seancenih MATH GRTMATE SHON eof he Cyan NM ALWAYS WEAR YOUR CERTIRCATE ath Oth ‘ie urren ter ice PROT FERTION OF YOUR a HEALTH CERTIFICATE OAT GD ONEY ONT THE NEXT Dat [sAMINATN AS NOIEATED BELOW * 2 muitersuistr 9s rot Gn? anda ‘aol apatan Nave one xno __[oareorenr occurAtion: c8___st___NaTIONALITY 7 PLACE OF WORK: bare KIND esr to, SENATOR nee = SHOU OTHER BAN by | SSRERTCTIRCE are a eso. (CROATTOH ONT om Fem) BACK em Fond 6HEALTH CERTIFICATE FO) ATTENDANTS, RECEPTIO! HOSPITALITY GIRLS / BOYS, ETC. (PINK COLOR) )R MASSAGE CLINIC NIST, HOSTESSES, Office of thee City/Municipal ENS FORMNO. 1A | Health Officer SANITARY INSPECTION OF FOt )OD ESTABLISHMENT tablshment Category. = Ovener/Manager crs romno wma Owner cars eh Logeot cin vet No of Pesnnel____— No. with Health Cerfete Santry Pema No Maricipaiy TRANSFERAT es WEAR YOUR CERTUICATE IN xf oir A cea Seo acura Pre Tage PORTION SE TEMS avanti] —“RECONaENDED ca [EE er oreoF SE (O1 [CORRECTIVE MEASURES Bghe LTEETTETE® | examamaton sBINDICATED BELOW. ERI et HEALTH CERTIFICATE ——— saan Ge pecans eens naantzation iG hae owe sono__| pareor ext “4 CONSTRUCTION GF PREMISES occuPATION Ee 5. MAINTENANCEOF PROMISES |AGE__SEX____NATIONALITY et 6 TOILET PROVISION Pace oF WORK ae se 7. ANOWASHING FACITISS a waren suet 1 Tene Foote oR a Lenser sueree picuae J ‘exo RESULT 5. tiger \GEMENT SSE GTARGE To, SOLIDWASTE MANAGEMENT ve "(CHO/ MRO) 5 1. WHOLESOMENESS OF FOOD 12. PROTECTONOF FOO fe.» Se. FRONT 04 ) 15. VeRNAIN CONTROL es POHANG HE 14. CLEANLINESS AND TIDINESS IRETRALICERVICAL SMEAR EXAM N STD EXAMINATION u *m aes 15. PERSGNAL CLEANLINESS BE [armor | eee [SE [weer petra 16 ROUSEREETING AND MANAG |S 17, CONDITIONS OF APPUANCE w UTENIES akg EXAMINATION 16. SAN CONOMMONEOF APPLANCESG UTES aaitor aE 19. ISEASE CONTAOL ‘BAM NEXT ESAS. 20, MISCELLANEOUS TOTAL DEMERITS HBsAg EXAMINATION NOTE: Nowcompyngtemare eat thant. Ey ach = TaTOF Nomisweigedvin denen erning ae waeer [ness | seaveuon PERCENTAGE RATING ingot ebatsnet rere 19 be Sorert {00% Lee Demesit Seore) “SS onSccthnopeaerSapeemepre ame E= SANITATIONSTANDARD " PEACENTAGE RATING ikea eNO sine vinvsarencrony 2: ee Samsenctonr 9: 5 eccivedy Cone Tipe Sang oper BACK (idem, x Sem) “4 ne 65SPECIAL FEATURES ITEMS o “ © oe o © o w o EATING & DRINKING ESTABLISHMENTS {lnsloing Hotels Motels, Bearing Houses & the likes, Resturats, Coffe Shops, Canteens, Pansies Dino, Corinda, Fast Foods, Refreshment Rooms/Parlors, Cafeteria, Snack Bars, Cocktail Loungs, ‘are Dee, Nigh Clubs 2 similar establshmens) Cleaning food utensil (prescribed mettod) 2. Food protection (specifi requirements) 3. Kichen BAKERY, BAKEHOUSE, BAKESHOP, CAKE SHOP, CAKE KITCHEN 1 Stoage/ictection, ingredients 2 Sorogerpotetion oor 5. Candiion of fixed appliance DELICATESSENS 1 Sepuration,cooked/uncooked meats 2. Usevoked pouty, wrapped 53. Conmoa eating deviee [BUTCHER SHOPS, MEAT SHOP. FISH SHOP 1 Stoageprotection, meats 2. ‘Foo oatact surfaces 3. Disposal. bonesastes SALE OF ICE CREAM/FROZEN CONFECTIONS 1. Storage of servers 2) Stertzing server. 3. Protection. cones wafers, zen feds, ee ICE CREAM MANUFACTURE 1 Cleansing/teriiing planveguipmert 2. Stovagelprotecion ingresients 5) Bflecivenest of” po touch" teebrigues MILK sHOPS 1 Mil emperture 2. Approved storage somparment 3. Sale other produ MILK STORAGE/PENDING RETAIL SALE 1. Relrigeratea storage 2, Setfclesing doces 53. Exclusion of comaminatng substncss [STORAGE/BOTTLING RAW MILK. 1 Cleansinglseriizing bot 2. Mechanical capping 3 Storagerrotecton boule aps RETAIL SALE OF LIQUOR, 1). Glassreshing/storage 2. Nosmoking, et. 3. Demijha washing 66 4 10 3 stone vr saQUON WINE SELLER |. Testing room, sink, hot and cold water . 2 Gevaingssge beacee 5 Sone Sinai cos see ) BREWERIES 1 Storage/preection, brewing ingrediens 2 Cleansing/torage, botes/eontsiness 3. Disposal of speat hops and yeast Him) WINE MAKERS 1. Cleansing/strage, bottestontiners 2 Disposal: mark ad wastes 41 Storage containers, corks ete ACTERE OF AERATROWATERS& ‘Cleansing/storage. bottles BEVERAGES 2 Gomme 5 Saree ©) GROCER'S sHORS (laclocing thse ot oterwite registred) 1 Preto iy food orageortectin, perishable food 3. Balk store and packaging » ng thw on hori ei 1. Food off ground ‘esers) 2 Stogedepor wae 3. Pectin sei at (STORAGE. PACKAGING & PLLPING OF EGGS |. Cook. dimp-proot siorage for whol eges, 2. Candling equipment 3. Food comet sintces 6 manwers 1 Seprtion of fom ce post 2 Choisy of pouty cages an pe 1 Wane sorge& dips @ Avartoirs 1 Approved plan 2. Staughcering of aia 3. Container or ese (pectic requirements) 7