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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />13.Nai <br />14.Completed by: <br />Sig Title <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />Propane Stove Bleach <br />IPropane Tank <br />Rinse Water <br />Fire Extinguisher <br />Ice Cooler <br />eH8d?6-o2 HaZelt°n Avenue 1 Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd corn <br />07/3/17 Page 8 of 11 '07/3/17 TEMP EVENT APP <br />Soap and Water <br />Sterno w/Chaffing <br />Dish <br />Extra <br />Water <br />5 Gal Hand wash <br />Wastewater Container <br />at all hours of <br />ks prior to <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br /> <br />Extra Ice Bags & Food Containers must be <br />stored 6 inches off of the ground! <br />5-20 Gal. <br />Hand wash Water <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp.7/ <br />0 <br />All foojd'venot " ■■ <br />preparatigj/for this event, <br />prepap <br />this/ev <br />Ion container with spigot). <br />□xxc “°S.items 'vi,hin my boo,h for lhe sani,ary p—» <br />ipy of this checklist must be in the booth <br />Return original to festival coordinator threq weeks pi <br />Date ' ' <br />Garbage <br />Can <br />“PP* —■ rinsing and one for a bleach <br />□^Detergent, bleach, and wiping cloths (cleaning towels). <br />MS^Tub to store wiping cloths in bleach solution. <br /> Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gait <br /> One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />^^Paper towels and pump-style soap container. <br />boaoThPr°Vidin9 thS f0"°Win9 f°r adequate hand washin9 f^iiities, but separate from utensil wash within my <br />SAN JOAQUIN <br />------COUNTY------- <br />Greatness grows here. <br />^•PFrX9 POten“* “s f°°* ba'P» <br />I3\Jce chests | | Refrigerator <br /> Refrigerated truck |ce bath and tubs <br /> Other (specify) <br />LT <br />—4 J <br />^Important** <br />o^responsible^erso^ptejresent in booth during all hours of operation: <br />Dtikl o ------------------------------- <br />or th!?? arte tO iasPection- Please make a copy of this application in <br />Ion and operatii <br />ot.