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Environmental Health Department <br /> <br />10 <br />11. <br />OR <br />12. <br />minimum of 100T (i.c. 5-20 gallon container with spigot). <br />13. <br />“Important" <br />14.rdnature <br />| Health PermitJ'| P.ipix KanJ lewd* |I 1 <br />| (Hearn <br />Ice Cooler <br />ar4 V-dc' <br />(' CH <br />Title <br />1B60 I-. I lazolion Avenue | <br />( Hl) io o? <br />twr.vi? <br />(jatliago <br />Can <br />Hj n 11 C- J Cor.:.! r»-.» I r <br />11 c-t i-t t'.C " <br />Slc«'O*'C(ia"‘',g <br />IrfStl <br />$.ir.t icr tucKel- <br />l.lonr)' 4 wMO'tor <br />j-xing wip-nj ctollu <br />Booth must be on <br />Concrete. Asphalt. <br />Plywood, or a Tarp <br />j SoapArpor’Of <br />preparation and <br />thlfrfovent.. y <br />Completed by <br />SAN 10A0UIN <br />c •. • i i:! > <br />| Cici aie U"» <br />........ <br />nice chests ^Refrigerator <br />(J Refrigerated truck (J Ice bath and tubs <br /> Other (specify)------------------------------------ ------- -------------------------- <br />- 209 468-3420 | F 209 464-0138 | WWW.Sjcehd com <br />P.igo 0 of 11 <br />| f.o.1111-d V. -•(<•> | <br />I, o I ' <br />I providing the rolloxving .terns within my booth for the sanitary cleaning of food preparation utensil <br />Three compartment sink <br />LJ Three deep tubs (basins 6-8 inches minimum) one <br />solution (one tablespoon of bleach per gallon of water) <br />XOetcrgent. bleach, and wiping cloths (cleaning towels). <br />MjTub to store wiping cloths in bleach solution. <br />fam providing the following for adequate band washing facii.ties, but separate from utensil wash »thin my <br />booth: <br />Water supply dispenser with warm water at a <br /> One separate tub (bucket or basin) tor the collection of rinse/wastewater. <br />M Paper towels and pump^tyle soap container. <br />Name responsible persons to be present in booth during all hours of operation: <br /> <br /> UfJ/'iry' /A /-/—-—-— <br />EX and XX: RoZ^altotosd^^ <br /> 3 <br />[ Cut' ii'J (('• ■•'4 <br />j f'r. M-’ie <br />n.aje Wato' <br />j J I bG-ilH.'ndwash <br />' |.l V.’iitoA.ltor Ce. I'.vrM'"C I |I <br />Stockton, California 95205 | T <br />(or soapy water, one for rinsing and one for a bleach <br />.Date