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Environmental Health Department <br />10. <br />12. <br />utensil wash within my <br />13. <br />14.Completed by: <br />Signature <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />Propane Stove Bleach <br />nPropane Tank <br />Rinse Water Bleach and Water <br />Fire Extinguisher <br />preparation for this event, <br />preparation and operation. <br />this event. /7 <br />Extra <br />Water <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp, <br />5-20 Gal. <br />Hand wash Water <br />1 5 Gal Hand wash ]. <br />Wastewater Container I <br />Nar^ Qj.gsponyie persons t° be present in booth during all hours of operation: <br />■. 3 ■ <br />’1' KSXS"6™ my b”‘h ,OrSani,a'7 “'“"i"9 0‘ '00d l»W°" “tens! <br />OR <br />for ""-9 - <or O bteach <br />□ Detergent, bleach, and wiping cloths (cleaning towels) <br />LJ Tub to store wiping cloths in bleach solution. <br />‘‘‘'Important** <br />Extra Ice Bags & Footf Containers must be <br />stored 6 inches off of the ground! <br />Sterna w/Chaffirig <br />Dish <br />A** * ,*-~l <br />t - X SANjJOAOUIN <br />. - ■ — COUNT Y— <br />f-ar<»e*n»s3 pro'.v.s ■•'er?. <br />□ Jce-chests Q Refrigerator <br />0Refrigerated truck |ce bath and tubs <br />□ Other (specify) <br />i—f. f <br />Soap and Water <br />tTWater supply dispenser with warm water at a minimum of 100T (i.e. 5-20 gallon container with spigot). <br />□ Ope separate tub (bucket or basin) for the collection of rinse/wastewater. <br />^0 Paper towels and pump-style soap container. <br />eswwwwww <br />Health Permit I <br />booThP^’"9 the f0fl0win9 for adecluate hand washing facilities, but separate from <br />^D6®6SHaZSlt°nAVenUe| Stanton, California 95205 | T 209 468-3420 | F 209 464-0138 ( www.sjcehd com <br />07/3/17 Pagesorn tempeventapp <br />Al^Ze_nlOr ,b00ths are s^ject t0 inspection. Please makZTcopy of this appfcSoTin <br />A copy of this checklist must be in the booth at all hours of <br />jgeturn original to festival coordinator three weeks prior to <br />—■ 5- <br />Title Date <br />Ice Cooler <br />j'Yjj