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mtEnvironmental Health Depar* <br />10 <br />11. <br />OR <br />12. <br />13. <br />Completed by:14.Signature <br />Health Permit KlTftngSwmo <br />CU>sBo*<5 <br />Propene Skx <br />RrtMW»»r <br />Ice Cooler <br />Payo BoMl <br />Waixreet* Conar** <br />Sworn OucMv <br />biMcft a ** <br />tfortns <*** <br />1868 E. Hazelton Avenue | Stockton, <br />Er® 16-02 <br />07/OV2024 <br />5-20 CM. <br />HOrtJ »••**••* <br />Garbage <br />Can <br />All food vendor b< <br />preparation for th <br />preparation and/ <br />this event / <br />F KX* Hjna To««H | <br />I Som1«*» <br />Booth must been <br /> Concrete. Asphalt. <br />Plywood, or a Tarp. <br /> »____________ <br />209 464-0138 | ***-s»9°^°e'^®?app <br />Un »c* nvl Im <br />6 off of grourd' <br />California 952051 T 209 468-3420] F <br />' SAN JOAQUIN <br />------COUNTY------- <br />Grcoinetr ^rows hrrr <br />04ce chests Refrigerator <br />fl RafrrgoratBd truck D Ice bath and tubs <br />O Other (specify),_—-------------------------- -------------- <br />— ' : please make a copy of this application in <br />A^yVyircheckbst must ^.^^Xks'Slor to <br /> <br />' Title Oa* * <br />I am proving the folkwng .terns with® my booth for the san.tary cteanog of food Preparat»n utens.1 <br /> Three compartment sink. <br />««, ». (MW. M «—>■ «• "rr —• ~*“ <br />V^uton (one tablespoon of bleach per gallon of *a”’r)- <br /> Detergent, bleach, and wiping cloths (cleaning towels) <br />[~] Tub to store wiping cloths in bleach solution <br />, „ p„^ M <« -«-»■— —«• —*"1 <br />booth: <br />, lo» ««*« « •-»> »» <br />>er towels and pump-style soap container. <br />Barnes of responsible persons to^resent in booth dunng all hours of operaton <br />^Mrtarrt- "All food vendor bo/hs are subject to inspection. <br />rtion.