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Environmental Health Department <br />10. <br />12. <br />13. <br />“Important** <br />14.Completed by: <br />Signatui <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Propane Stove Bleach <br />itPropane Tank <br />Bleach and Waler <br />Fire Extinfluisher <br />l?o^2HaZel,OnAvenuel Stockton, California95205I T 209468-3420 | F 209 464-0138 | wwwsjgov.oro/ehd <br />06/10/10 Page 8 of 11 __o _At06/10/10 TEMP EVENT APR <br />Stemo w/Chaffing <br />Dish <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Extra Ice Bags & Food Containers must bo <br />storod S Inchou off of tho ground! <br />5-20 Gal <br />Hand wasp Water <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />Ice Cooler i <br />- I.' <br />SAN JOAQUIN <br />-----COUNTY <br />__1 <br />Soap and Water <br />_z <br />Rinse Water <br />/Oi <br />Water <br />n,cechests ©Refrigerator <br />□ Refrigerated truck Q |Ce bath and tubs <br />□ Other (specify)— <br />but separate from utensil wash within my <br />n™?i^n?’r (K00,hS are SUbjeCt t0 inspection- Please make a copy of this application In <br />oreoaraton ^4^“ 'T" ' d C°Py 01 lhlS checkfet must I" the booth at aH hours of <br />thTs events/ d original to festival coordinator three weeks prior to <br />% 2. <br />Title |Ste <br />hemS my b00,h ,or ,he Sanitary clBa™9 °f preparation utensil <br />OR <br />El J^on^bles^r^bl^ ,Or SOapy watep rinsing and one for a bleach <br />m bleach, and wiping cloths (cleaning towels) <br />U Tub to store wiping cloths in bleach solution. <br />h^h.Pr0Vldin9 the fol,owin9 for adequate hand washing facilities <br />uooin • <br />QWater supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />&One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Draper towels and pump-style soap container. <br />Names ponsfoie booth durin9 al1 hours of operation: