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Environmental Health Department 'I <br />10. <br />12. <br />13. <br />**important** <br />14. Completed by: <br />Signature Title Date <br />Health Permit <br />Paper Hand Tareis <br />Soap dispenser <br />Cuffing Board <br />Propane SUxra BJeach <br /> <br />Propara Tank <br />Bteacn and water <br />Rra Extinguisher <br />EHD ?M2 ^aze*ton Avenue I Stockton. California 95205 | T 200 468-3420 | <br />mnut Page 8 of 1107/3/17 <br />Extra fee Bags & Food Containers ma be <br />amd e inches otfei the ground! <br />K] Water supply dispenser with warm water at <br />Kj One separate tub (bucket or basin) for th< <br />5 Gai Hand wash <br />Wastewater Container <br />Stemow/Chaffing <br />Dish <br />P 209 464-0138 | www.sjcehd.com <br />TEMP EVENT APP <br />5^0 Gal. <br />Hand wash Water <br />Booth must be on <br />Concrete, Asphalt <br />Plywood, or a Tarp. <br />Sanitizer buckel- <br />bieachi waler for <br />Storing wiping ctoths <br />Garbage <br />Can <br />Soap and WMer ranse water <br />a minimum of lOO’F (Le. 5-20 gallon container with spigot). <br />ie collection of rinse/wastewater. <br />S Paper towels and pump-style soap container. <br />11‘ wahin my boo,h for ,he sanitary cteanin9 °f p-p-« on utensil <br />OR <br />SANJOAOulN <br />-----COUNTY------ <br />Urrvj -7?5 j prSsVS <br />Sice chests Refrigerator <br /> Refrigerated truck ®.lce bath and tubs <br /> Other (specify) <br />I ^vicKHg the following for adequate hand washing facilities, but separate from utensil wash within my <br />xSt^for soapy wa,er'one for rin3in9 and one for a bteach □.Detergent, bleach, and wiping cloths (cleaning towels). <br />LJ Tub to store wiping cloths in bleach solution. <br />for I?OthS a? S Abject to i"spection- p,ease make a copy of this application in <br />preparation for this event A copy of this checklist must be in the booth at al! hours of <br />Operaton- -Return original to festival coordinator three weeks prior to <br />c <br />-----------Ice Cooler : j <br />Names of responsible persons to be present in booth during all hours of operation <br />-----------TuPiin____________________ <br />Extra <br />Water