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Environmental Health Department <br />11. <br />OR <br />for rinsing and one for a bleach <br />12. <br />13. <br />14.Completed by: <br />Health Permit <br />PapwHwidTowrt. <br />Propwa Stove <br />Bteacti <br />PrapanaTank <br />.'7 <br />Ice Cooler <br />Garbage <br />Can <br />Senittwbucka- <br />Noacti&wriarfar <br />•torfnowWnodoih. <br />I.e. 5-20 gallon container with spigot), <br />iste water. <br />SoapandWeter <br />Hra ExUnauUher I <br />WnaaWaier I <br />I Extra <br />Water <br />•e sanitary cleaning of food preparation utensil <br />Booth must be on <br />Concrete, Aephalt. <br />Plywood, or a Tarp. <br /><------ ----- -- J <br />5-20 Gal <br />HwtoweshWMar <br />10. <br />Soap Otepamar | _____ <br />UlxJl <br />Btaacti and Water ____| <br />L______ ]/ <br />•fared a Inch" oH oftht gnundl <br />ehd ?6^ Haze,ton Avenue | Stockton, <br />07/3/17 <br />B<MHandwMh <br />WaMMMtor Container <br />■if SANJOAOUIN <br />-----COUNTY------ <br />yiui,-5 /icu?. <br />r-t „ 8 Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify) <br />preparatforPfor tti“ event ?W <*this application In <br />=on and operation, <br /> . Ct^e^- <br />Title Date <br />CalUomia95205| T 209 468-34201 F 209 464-0138 | www.ejcehd.com <br />TEMP EVENT APP <br />teXXS.it8ms wi,h,n booth for <br />for soapv °"a <br />l^m providing the following for adequate hand washing fadlffles, but separate from utensil wash within my <br />Boater supply dispenser with warm water at a minimum of 100T (1. <br />SJne separate tub (bucket or basin) for the collection of rlnse/wa <br />0Paper towels and pump-style soap container. <br /> durina a"hours o,opera“°n: <br />“Important**are subject to inspection. Please make <br />preparation and operation. <br />jyent. <br />/X Slgriata£?