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t3C>14W0y/,4 p.2 <br />Environmental Health Department <br />10. <br />OR <br />12. <br />but separate from utensil wash within my <br />13. <br /> <br />14.Completed by: <br />Health Permit <br />Paper Hand Tow«bSoapdtapaoMr j <br />Arcpane Stow Btoech <br />r <br />r Bteaeh and YVWer <br />RmEidinguirier <br />J <br />Stemo <br />DM <br />5 Gpl Hand wa*h <br />VMtatewsferCnntakwr <br />Garbage <br />Can <br /><». SANJOAQUIN <br />■------COUNTY------- <br />SanmwbucM- <br />Maach* waler lor <br />staring wiping ctoita <br />l>ui\viqiioi'j l^cjii r>MM uoi ly <br />Q Ice chests Refrigerator <br /> Refrigerated track Ice bath and tubs <br />Q Other (specify) <br />Booth must be on <br />Concrete. Asphalt, <br />Plywood, oraTaip. <br />---------- / <br />I fctBaga s Food Oxitaiw? nvsl <br />| ganwaJnawafforftoqrotmdl ■ <br />^®^2Hazett°n A^nue| Stockton, California 95205 j T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br /><J7<’3H7 PooeSrfll TEMP EVENT APP <br />my bOOth far lhe sanitary c,ean'n9 of food preparation utensil <br />H bteach. and wiping cloths (cleaning towels). <br /> Tub to store wiping cloths in bleach solution. <br />I^^providing the following for adequate hand washing facililies. <br />GM <br />r- Handwcsh Wator <br />Ice Cooler ! <br />____________l> <br />"toiportanr* All food vendor booths are subject to inspection. Phase make a copy of this application in <br />e'^5 A “P* fhlS checWist m!jst be in the booth at ail hours of <br />thteeS operyo^;^aturn Prirtnel to festival coordinator three weeks wfor to <br />Signature <br />QWater supply dispenser with warm water at a minimum of 100«F (i.e. 5-20 gallon container with spigot). <br />Q'^ie separate tub (bucket or basin) for the collection of rinseAirastewater. <br />□'Paper towels and pump-style soap container. <br />SMpmvtauTjl Rmhwsm | I" <br />A <br />A checklist r^st be io th? boofo u <br />/Return original to festival coordinator three weeks <br />M -31-1?' <br />ntie Date <br />it