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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />13. <br />14.Completed by: <br />Signature Title Date <br />Health Permit <br />Paper Hand Towels <br />Soap dspenser <br />Cutting Board <br />Propane Siovo Bleach <br />Soap and Water <br />Fire Extinguisher <br />Ice Cooler <br />Page 8 of 11 <br />Extra <br />Water <br />Extra Ice Begs & Food Containers must be <br />stored S inchos offot tho ground! <br />MO Gat <br />Hand wash Water <br />www.sjcehd.com <br />TEMP EVENT APP <br />Stemo w/Chaffing <br />Osh <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Booth must be on <br />Concrete, Asphalt. <br />Plywood, or a Tarp. <br />Sanarzor bucXet- <br />bleach & water for <br />storing w.pmg doths <br />k^Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gaili <br />^One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />^^Paper towels and pump-style soap container. <br />Ion container with spigot). <br />7 . 1 . <br />Rinse Water <br />1868 E. Hazelton Avenue | stockton. California Q520G I T 20Q 4G8-3420 I F 209 464-0130 I <br />EHD 154)2 Page 8 of 1107/3/17 aye out II <br />SAN JOAQUIN <br />------COUNTY------- <br />1 “* “ <br />'Sjce chests Q Refrigerator <br /> Refrigerated truck |Ce bath and tubs <br /> Other (specify) <br />**lmportant**All 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 festival coordinator three weeks prior to <br />this event. —--------------e---------- <br />MBmgs^of responsibte p^rson^to be present in booth during all hours of operation: <br /> <br />Propane Tank <br />boaoTbPrOVidin9 the f0"°Win9 fOr adequate hand washing facilities' but seParate fr°m “tonsil wash within my <br />for WateP °"e for a htoach <br />O Detergent, bleach, and wiping cloths (cleaning towels) <br />IJ Tub to store wiping cloths in bleach solution.