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Environmental Health Department <br /> <br />10. <br />11. <br />OR <br />12. <br />my <br />13. <br />“Important** <br />14.Completed by: <br />Paper Ha k! TowelsSoap dispenser <br />Cutting Board <br />Propane Stove <br />Bleach <br />nust be on2I <br />15 <br />Propane Tank <br />■^7 Rinse Watar Bleach and Water <br />Fire Extinguisher <br />__L <br />Soap and Water <br />Garbage <br />Can <br />Stemo w/Chafting <br />Diab <br />5 Gal Hand wash <br />Wastewater Container <br />Sanitizer bucket- <br />oieacti & i rater for <br />storing wip ng doths <br />Booth <br />Concrete. Asphalt. <br />PlywootJ, ora Tarp. <br />Health Permit <br />Page 8 of 468'3420 I F 209 464-0138 I www.sjcehd.com <br />TEMP EVENT APP <br />Ion container with spigot). <br />Extra Ice Bags & Food Containers must bo <br />stored 6 indies off of the ground' <br />5-20 GM <br />Hand wash Water <br />Ice Cooler ; <br />one for rinsing and one for e bleach <br />larn^providing the foltowing for adequate hand washing facilities, but separate from utensil wash wjhin <br />M Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gall <br />1*3 One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />M Paper towels and pump-style soap container. <br />Names °f ^ponsjbte perso^ote^present in booth during all hours of operation: <br />SAN JOAQUIN <br />------COUNTY------- <br />C-recL-'erc ghsr:. <br />45”F (if food is us^SolXingTaTmaintaTb^oW^FtemTOe)01 ha2ardous footis below <br />°ICeCheS,S □Refrigerator 7 <br /> Refrigerated truck Ice bath and tubs > 7 <br /> Other (specify) 7 <br />All food vendor booths are <br />preparation for this event. <br />preparation and operation <br /> zzzL2S^ <br />Signature <br />SSEEBESS <br /> <br />Title Date <br />s- L_ <br />ehd ?6^2 Ha2elton Avenue I Stockton. California 95205 | T <br />07/3/17 <br />my fOr the Ctea™9 oHood preparation utensi. <br />zMutolrWnn^PKt|UbS (basi?s 6-8 inches minimum), one for soapy water <br />nS± ofbleachper9al,onpfwater).n Tiih to e?t’ b each’ and w,P,ng cloths (cleaning towels). <br />U Tub to store wiping cloths in bleach solution.