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Environmental Health Department <br />10 <br />11. <br />fw rinsing and one for a bleach <br />OH <br />separate from utensil wash within my <br />12 <br />13. <br />•‘fmportanf <br />Completed by -14. <br />ire <br />Health Permit <br />tr <br />>*«aev« >*-* <br />tzwKlwrSaavaMWaw <br />tamaatO'aR*^ <br />U>f <br />£>»a na aa«i t *oo« CaMamn ■»> •» <br />■aaw * »x**i aifar *t *<a<«w* <br />tan <br />«aw <br />iCM'MMMtt' <br />aiwma' Cortarar <br />S«nanr»MO*> <br />twKf A «wa« 1<X <br />tVi-iwrjtigM <br />1868 E Hazelton Avenue I StocMoc California 95205 | T 209 468-3420) F 209 464-0138 | www sjgov org/ehd <br />E"O'6-C2 PagaiatV lEt^tVtNTKPP <br />0X9117024 <br />Ice Cooler <br />my booin lor me sectary deanmg of <000 p,ePa.al«m uleosl <br />I nacr <br />All food vendor booths are subject to inspection <br />preparation for this event <br />preparation and operation. <br />this event. < <br />J Ioan <br />C?' ra <br />Gartwge <br />Car <br />I anrproviding the foitowng items <br />[^Three compartment sink. <br />1 Three deep tubs (basms 6-8 inches mmanum) one for soapy water, one <br />imn mre tablespoon of bleach per gallon of water i <br />n STX< w*" •’•‘V **’.<*’’"» «">*1 <br />□ Tub to store wiping cloths in bleach solution <br />, am pmvdmg me roWmng «x adequale band wash,ng laahaea. be. <br />booth <br />34m dnpenser Xb .arm waler a. a rnn mum 0. -OCT (U. obnla.ner wilb <br />□ One separate tub (bucket or basin) for the collectKin of nnsefwastewater. <br />□ Paper towels and pump-styte soap contaner <br />Names of responsible persons to be present m booth dunng al hours of operation <br />Pro CttguftQM ~tu6m______________ ___ _—------------ <br />z---------------------\ <br />Boosn trust De or <br />Conczeic Asphaft. <br />P y*ooc Of J Tarp <br />___________J <br />----------Please make a copy of this apptcabon m <br />A ^y’of th.5 checklist must be m the booth at^atl hou^ of <br />Return original to fcst!yal_cggrdinatgr—ree w-------- <br />wauGcm______2( d is <br />Title Dau? <br />SAN JOAOUlN <br />t, '• ------COUNTY------- <br />' Greotneil <;rows Herr <br />foammng rrld mmporalbrn conW for mo cr-d hrMng ol ootenbalb, barmdon. <ood. ootaw <br />' 1 . JKU. day ma.mam betow «T mmoermorc) <br />□ me enema Cl Hemgeralo. <br />^ngerawd.mea Q ice bam and lobs______________ _ <br />□ Other (specify)----- ------- -----------------------------—