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12. <br />13. <br />Date <br />14.Signature <br />Paper Hand Towels <br />1 3Bleach <br />Bleach and Water <br />latWiasr# <br />5 <br />5 Gal Hand wash <br />Wastewater Container <br />Slornow/Chafling <br />Dish <br />-| T 209 468-3420 1 F <br />Page 8 of 111868 E. Hazelton Avenue | <br />EHD 16-02 <br />n-//n/4 7 <br />Soap dispenser | <br />Environmental Health Department <br />Propane Tank I <br />^Ice Cooler”^ <br />LI <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />Soap and Water I <br />10. <br />11 k^providing rne^iu <br />OR <br />209 464-0138 | vMW.sjcehdxom <br />I Cutting Beard <br />Propane Stove <br />- \ z' ' <br />Stockton, California 95205 | <br />Fire Extinguisher <br /> <br />& SANJOAQUIN <br />") ------COUNTY------- <br />Rinse Water <br />^Health Permit <br />life 3 <br />' Greotness grows for the cold holding of potentially hazardous foods below <br />^KSiS" <br />— c- k ^X-s <br /> Refrigerated truck U s —------------------------- - <br />□"Other (specify).------------ ------------------------------ - <br />SSSSESH......... <br />...................-......-................... <br />Q Ona separate lub (buck..-W—o> — <br /> QlCper towels and pumpj^tylesoaB container. <br />------------------------------------------------------------------------------------------------■ <br /> -—• <br /> <br /> <br />iliisj^snt <br /> Completed by: -----—Title <br />I 5-20 Gal. <br />r— I I land wash Water