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Environmental Health Department <br />11. <br />)R <br />**lmportant** <br /> <br />Completed by: <br />Title <br />Health Permit <br />P«P* Hand TowelsSoap dispenser <br />Cutting Board <br />pane Stove Bleach <br />I <br />Rinse Water Bleach and Water <br />nnn inrnnrt <br />UK MM <br />Stemo w/Chaffing <br />Dish <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Sanitizer bucket- <br />bleech & water for <br />storing wiping cloths <br />5-20 Gai. <br />Hand wash Water <br />I Water <br />/ —j —-j M <br />Soap and Water <br />3 Cooler J <br />| Fire Extinguisher <br />10. <br />Extra fee Bags 4 Food Contakrera must bo <br />stored 6 *>chos offoftha groundl <br />Booth must be on <br />Concrete, Asphalt. <br />Plywood, or a Tarp. <br />—----- <br />5 E. Ha7P>ltr>n A\/aniia I o_i:x___ <br />M Water 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 />SsPaper towels and pump-style soap container. <br />L Names of responsible peraons to be present in booth during all hours of operation: <br />— / I f v *7 /1 C-'c—____V/O <br />-------------- ______________________________y//a kJ <br />Signature -------------------- <br />- SANJOAQUIN <br />-------COUNTY------ <br />i.-oji-'- Greatness grows here. <br />45’F0fVSfeusedZfol^ng^maWahP0,entia"y hazardousfoods below <br />□'^chests Refrigerator <br /> Refrigerated truck ice bath and tubs <br />Q Other (specify) <br />□ Thi^ ^^Xnentsink ^h18 bOOth fOr the sanitar* oje^ing of food preparation utensil <br />'“p, —■ “• w *-"• ■“ ■ "■“ <br />booth? 9 th® fo,,owin9 for adequate hand washing facilities, but separate from utensil wash within my