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Environmental Health Department <br />10. <br />11. <br />for rinsing and one for a bleachOR <br />12. <br />hjiothl <br />"Important** <br />Completed by.14. <br />Health Permit Paper Hand Towels <br />Cuttina Board <br />Propane Stove <br />Propane Tank <br />Bleach and Water <br />Fire Extinpuisher <br />LIce Cooler <br />Stemo w/Chafling <br />Dish <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach & water (or <br />storing wiping cloths <br />5-20 Gal. <br />Hand wash Water <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, ora Tarp. <br />s of operation: <br />209 464-0138 | www.sjcehd corn^ <br />Extra Ice Bags S Food Containers must ba <br />stored S inches off ot the ground' <br />1868 E. Hazelton Avenue 1 Stockton, California 209 4o8 3420 | F <br />EHD 16-02 <br />07/3/17 <br />| Soap dispenser |------------ ' <br />Bleach I <br />WO <br />SAN JOAQUIN <br />—COUNTY------ <br />, am PX « Xpe^co^t-« PO-* “ * <br />45°F (if food is used the following day, maintain below 41 F temper ). <br />□^chests Refri9erator <br /> Refrigerated truck lce bath and tubs ______________ <br /> Other (specify)--------------------- ------------- ---------------------------- <br />, am providing ihetoiiowing kemswithin my booth for the sanita^ meaning of food preparation utensil <br /> Three compartment sink. <br /> Three deep tubs (basins 6-8 inches minimum) one for soapy water, one <br />solution (one tablespoon of bleach per gallon of water) • <br />□□Detergent, bleach, and wiping cloths (cleaning towels). <br />□-Ttlb to store wiping cloths in bleach solution. <br />, am providing the Wowing for adequate hand washing faciiities. but separate horn utensii wash within my <br />booth: <br />D^ter supply dispenser With warm water at a minimum of 100T (i.e. 5-20 gaiion container with spigot). <br />^□^e separate tub (bucket or basin) for the collection of rinse/wastewater. <br />^J^^aper towels and pump-style soa_p container. <br /> is. Nameyt^ib/ <br />All food vendor booths are subject to ,n^c^"ck^®a^s?beein the ^ootti at all hours^of <br /> <br />A I (signature T,t^___________D ' <br />Soap and Water Rinse Waler <br />I Extra \ <br />Water