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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />my <br />13. <br />14.Completed by: <br />Health Permit <br />Par* Hand rw^K <br />CdOmq (korfl <br />PtopwSknv <br />iProp<»w Tart <br />[ <br />?»• t*l«XJUVW <br />SaraUw txaAM- <br />NMCft&aMwkr <br />Monng »>pve Ooffu <br />5-20 Gai <br />Hand amft WMar <br /> Ice chests <br /> Refrigerated truck <br /> Other (specify) <br />5 Gal Hand awah <br />WaMraalai CmtWW <br />Garbage <br />Can <br />Booth must be on <br />Concrete. Asphalt <br />Ptywood. or a Tarp. <br />__J <br />Soap and Wa«a> <br />Ion container with spigot). <br />I Waacn <br /> *» ‘‘“9‘ * rood ContoOaranaoiba ■atenadSHcftaaoirurm.j^ndr ■ <br />1868 E Hazelton Avenue I Stockton. California 95205 I T 209 468-34201 F 209 464-0138 I www.siqov.oro/ehd <br />ft <br />Ice Cooler <br />^j/Vater supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallt <br />One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Paper towels and pump-style soap container. <br />Names be present in 600111 durir>9 al1 h°urs of operation: <br />"Important** <br />sanjoaquin <br />-------COUNTY------- <br />Grcotnest growt here. <br /> Refrigerator <br />O Ice bath and tubs <br />k ___________ _____ ____ <br />^ThP^Xent^^"emS^hin mybO0"’,Or,he “"'Waning of rood pmperadon u<erai <br />0"e "H8'"9 <br />LJ Detergent, bleach, and wiping cloths (cleaning towels). <br />LI Tub to store wiping cloths in bleach solution. <br />So«pdnpcnt« I ______ <br />^providing the following for adequate hand washing (acililies. but separate from utensil wash within <br />r2__, <br />RnaWMM I 1 <br />fi <br />f.-i --------- <br />AJI food yendor'booths are subject to inspection. Please 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 /> thffevent1 a/*1)OperatlOn ^um original to festival coordinator three weeks prior to <br />-------------____________________pLMtng- ^/zs/zy <br />Z Signature Title “^DatA ' <br />StomowOiafhng <br />D»Vi 1