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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />13. <br />“Important** <br />14. <br />I I’nporllnnd Towels <br />| Soap dlsponsor | ----- <br />Slorno w/Clinlt<i>o <br />I Huh <br />Garbage <br />Gan <br />Sanitizer Ixickot- <br />Moach a water for <br />storing wiping cloths <br />Booth must bo on <br /> Concrete, Asphalt. <br />Plywood, or a I aif). <br />.. ................. ;; <br />Ice Cooler <br />Ciiuintl Hoard | - <br />[ lUoadr <br />| 1’iop.ino 1 nnk <br />separate from utensil wash within my <br />o <br />Kelo2^._Q— <br />cleaning of food preparation utensil <br />X I’lGp.inn Slovo | <br />SOnlllnndwnsIl i <br />V/astow.ilor Container <br />Klnso Water | | Biondi and Waler <br />I lixtrn \ <br />Water <br />I /:Xlr,i Ico Hops «/ <x>dCor>Mi)»»si»M«'««’ ‘1 I <br />slo/cd 6 Inchos oil ol tlui yioundl •' 1 <br />A.™.! 1 <br />(Ill) 10 02 <br />07/3/1? <br />| Soap nnrl Water <br />I Ito I xtinniilshor | <br />| I lealth Permit <br />SAN JOAQUIN <br />COUNIY <br />1 po,en,ia"y hazardous ,00ds bc,ow <br /> Ice chests f/k Refrigerator <br /> Refrigerated truck I Ilce bath and tubs <br /> <br />[>| Other (specify) <br />I am providing the following items within my booth for the sanitary <br />I^Jhree compartment sink. <br />□ Three deep tubs (basins 6-8 inches minimum) one tor soapy water, one tor rinsing and one tor a bleach <br />solution (one tablespoon of bleach per gallon of water) <br /> Detergent, bleach, and wiping cloths (cleaning towels). <br /> Tub to store wiping cloths in bleach solution. <br />I am providing the following for adequate hand washing facilities, but <br />booth: <br />, -| water supply dispenser with warm water at a minimum ot 1 DOT (i.e. 5-20 galion container wth spigot). <br />K] One separate tub (bucket or basin) for the collection ot rinso/wastowator. <br />[/[Paper towels and pump^tyle soap container. <br />Names of responsible persons to bo present in booth during all hours of operation: <br /> o< jnVV-lr--------------------- - <br /> <br /> <br />o 0 Ou. OiOrW' _ „ <br />Completed by:-------- --------------------------------------------------------- Title Date <br />6-20 Gal. <br />Hand wash Water