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Enwonmental Health Department <br />10. <br />11. <br />OR <br />12. <br />13.>rsons to be pi it in •ring all hours of operation: <br />"Important** <br />14.Completed by: <br />Signal <br />Health Permit <br />Paper Hand TowelsSoap dispenser <br />Cutfinp Board <br />Propane Stove <br />Bleaoh <br />0 <br />Soap and Water Rinsa Water Bleach end Water <br />oT 209 468-3420| F 209 464-0138 | www.sjgov.orgtehd <br />TEMP EVENT APP <br />1 .1 <br />Title <br />Garbage <br />Can <br />Extra <br />Water <br />S Gal Hand waeh <br />Wastewater Container <br />Sanitizer bucket- <br />bleachawaterfar <br />storing wifrinadoths <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, ora Tarp. <br />SAN JOAQUIN <br />0-20 sal. <br />Hana wash Water <br />3® ^zardous foods below <br />les chests i—i K '*— LJ HerngeratorRefrigerated truck Ice bath and tubs <br /> Other (specify) <br />Stamp w/Chefflng <br />DWl <br />preparation for this event, <br />preparation and operation, <br />this events <br />ehd ?b-02 Hai;eltori Avenue | Stockton. California 952051----- <br />ormomo Page 8 of 11 <br />W-Water supply di5penserwarrn water a, a of W0T (| e <br />I^One separate tub (bucket or basin) for the collection of rlnse/wastewater. <br />K^aper towels and pump-style soap container. <br />Names of responsible <br />□ Three compartmenUin9k.llemS my bOOth f°r the 8anitary cleaning of food preparation utensil <br />pMton ^XX^bl^^To" tfU^)ne fer 80apy water' one for and one for a bleach <br />I ara pravtdlng the folding for adequate hand washing facllta, but separate from utensil wash wkhin ray <br />S!^8 are y to Inspection. Please raake a copy of this application-|n <br />Return H ^lls1<;heJli8t must be In the booth at all hours of <br />Bqtum original to festival coordinator three weeks pr|or to <br />. fl' / 7 Date 1 <br />Propane Twk <br />L-- j Hre Extinguisher <br />1 ITT ----- <br />Ice Cooler !