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Environmental Health Department <br />10. <br />12. <br />13. <br />•"Important** <br />14. Completed by: <br />Signature <br />Health Permit <br />PwwrMMTowai <br />| PwfwwTent <br />-- *5 <br />Ice Cooler <br />^<■-^31 <br />□ Water supply dispenser with warm water at a minimum of 100T fi.e. 5-20 gallon container with spigot). <br />□ One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />□ Paper towels and pump-style soap container. <br />8GalHmd«Mi> <br />WMMMMrGMMWr <br />Garbage <br />Can <br />Santaartmcfcit- <br />HbMKhtMiarlpr ckMne'MfmcMh* <br />Boom must be on <br />Concrete. Asphalt. <br />Plywood, or a Tarp. <br />I S<w«**ptwr <br />SMp«WiMt«r <br />l^prowdlng the following for adequate hand washing fadftttas, but separate from utensil wash within my <br />SANJOAOUIN <br />— COUNTY----- <br />'" rsa .“ssss^r£i'.nzx's1‘, — <br />□ Ice chests Q Refrigerator <br />□ Refrigerated truck Q ice bath and tubs <br />□ Other (specify), <br />,or wapy water'on8 8nd “* ta 8 bte8ch <br />□ Detergent, bleach, and wiping cloths (cleaning towels). <br />□ Tub to store wiping cloths in bleach solution. <br />MOOM <br />HMdmirrWmr <br />AU food vendor booths are subject to inspection. Please make a copy of this application in <br />preparation for this event. A copy of this checklist must be in the booth at all hours of <br />preparation and operation. Return original to feetlvfil coordinator three weeks prior to <br />______________ <br />'Date <br />SttmoWCMOnfi am <br />Title <br />Names qtreeponsibte persons to be present in booth during all hours of operation: <br />_ <br />FrccwBSmw , <br />. ,.r z »i<«M —— •- » . . - v I* <br />-•< ••• . «• .>- I U——- - '1 » I -Iiifi- i -_ t rii n —w—r." <br />latt&HMNrtwAvmel StOddcm,QB^ia952051 T 209468-34201 F 2094644)138 | www.sjcehd.corn <br />11' ^Thr^X^enZ^"^ W'h'n my b°O,h ,W 'he " Ctea”fl feod <br />OR <br />| RkmMWtr 1 | teMEhmlWMr <br />A