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■ UPHaH <br />Environmental Health Department <br />10. <br />rJ A <br />11. <br />OR <br />12. <br />but separate from utensil wash within my <br />13. <br />*'lmportant‘“ <br />14.Completed by: <br />Health Permit <br />P»r>wH*ndTcw»t» <br />.^■7 <br />Ft* E^mguiihar <br />Ice Cooler I <br />209 464-0138 | <br />Sl«no w/CMrrmQ <br />D,V> <br />8«nMarbuck»U <br />t vrator for <br />•'ortnQw^fno cMhs <br />SAN JOAQUIN <br />- COUNTY <br />| C^inp Board I <br />I Propana Slav* , <br />| 1 ___ <br />Garbage <br />Can <br />I Propana Tar* <br />Ettra la Bagi t Food Comtintn muu ba <br />Uortd e Inata od ol lha ground‘ <br />ww'M8ov.org/ehd <br />TEMP EVENT APP <br />SOalHandwaih <br />Cort«n*< <br />Booth must be on <br />Concrete, Aaphalt, <br />Plywood, or a Terp. <br />' ’ S-^IS iT’XKlgZ, ™Sa“TXw VrF^mperahjre)0' P°,en,la"y haZard0US '°°dS bel°W <br />O|cechesls Refrigerator <br /> Refrigerated truck Ice bath and tubs <br />"'‘•ELpther (specify)__ <br />□XeXXSitemS d,b hr ,hB Sanl,a'y ctea"i"« ’°°d <br />S ,or wa,er'ona ,or rtn8i"9 a"d °"a for a biaach <br /> Detergent, bleach, and wiping cloths (cleaning towels) <br />U Tub to store wiping cloths in bleach solution. <br />boao7hPrOVidin9^je^'IOWin9 f°r adequate hand washing facilities, <br />□ Water supply dispenser with warm water at a minimum of 100T (i.e. 5-20 gallon container with spigot). <br /> One separate tub (bucket or basin) for the collection of rlnse/wastewater. <br /> Paper towels and pump-sfyle soap container. <br />be PreSent in b00,h dUr'n9 911 h°UrS of opera,ion; <br />th?°,hS ar.e SAbJeCt t0 insPection- p'eas* make a copy of this application in <br />preparation for this event. A copy of this checklist must be in the booth at all hours of <br />thte’eveiu' 8nd Opera,'On BgLMrn or|q|nal to festival coordinator three weeks prior to —to __ 0VN)Ur~ ^13 12-^- <br />^gnature 7^ ------ <br />05-50 Gal <br />r________, <br />| Soap dlipooior j ______ \ <br />io <br />HaZel,°n A''enUe 1 S>°‘*1°".ca«omla 95205 | T 209 4680420 I e <br />06/19/19 P»fl«8of11 <br />fllMfh»ndW*l«r | I <br /><—-