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t^ThPXXhm “n0S.i,en'S W"n my b“‘h ,or ,he ■*«** °f operation utensl!11. <br />OR <br />12. <br />13. <br />14.Completed by: <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Bleach <br />JPropane Tank <br />Rinse Water <br />Fire Extinguisher <br />Ice Cooler <br />Soap and Waler <br />5 Gal Hand wash <br />Wastewater Container <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />Stemo w/Chafflng <br />Dish <br />5-20 Gal. <br />Hand wash Water <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Extra <br />Waler <br />H Water supply dispenser with <br />□ On <br />MPs <br />MIW ikXIUIVV <br />45°F (if food is t sed th <br />CLlce chests <br />S3 Refrigerated tn ick <br />□ Other (specify)_____ <br />bSi-Pr°VIClin9 the f0,,0Wlng for adequate hand washing facilities, <br />Cutting Board I __ <br />Propane stove <br />**lmportant** <br />warm water at a minimum of 100T (i.e. 5-20 gallon container with spigot). <br />ie separate tub (bucket or basin) for the collection of rinse/wastewater. <br />□ Paper towels an 1 pump-style soap container. <br />JXXT’C °f -P-iion: <br />ehd8-02 Hazelton Avenue | Stockton, California 95205 | <br />06/29/2023 <br />Elution (onetablelpoonofbleaXtr^ato^i?)"6 S°aPy Water’ °ne ** nnsing and one for a bleach <br />LJ Detergent, blea and wiping cloths (cleaning towels). <br />l_J Tub to store wif ing cloths in bleach solution. <br />Garbage <br />Can <br />Extra Ice Bags & Food Containers must be <br />stored 6 iches oft of the ground! <br />D J" 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />3980 0(11 TEMP EVENT APR <br />;i <br />Jo <br />pieMration ?or thi ? SAbjec{ t0 ,nsPection- P'ease make a copy of this application in <br />P eoa aS S i f°Py °f this checklist must be in booth at ail houm of <br />tl is Xent/y-° °riC|inal tO feStiVa' COOr^nator three weeks prior to <br />-Zl_ ---------------ibM/93 <br />Si9"ature Tit|e ------------------ <br />(M Refrigerator <br />□ Ice bath and tubs <br />but separate from utensil wash within my