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4 <br />SAN JOAQUIN <br />f ■■ ■■ i • •. ; r <br />Environmental Health Department <br />10. <br />11.llemS W"hln b0°,h 'Or ’he Sanl,ary Cleanin0 of f°°d prepara"°'1 <br />OR <br />12. <br />13. <br />“Important** <br />14.Completed by: <br />Sig <br />Health Permit <br />PoporlliwNl Towola <br />Propane Stove <br />t <br />Propono Tank <br />'-'ire F.xtinfluieher <br />Ice Cooler i <br />n: <br />E«(m Ice Bugt I Food Contamon must bo <br />slorod 6 Inches oil ot tho groundl <br />Sterno w/Cberfing <br />Dl»b <br />S Gnl Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Booth must bo on <br />Concroto, Asphalt, <br />Plywood, ora Tarp. <br />5-20 Gnl <br />Hand wash Waler <br />Sanitizer buckol- <br />Moach A waler for <br />storing wiping cloths <br />/ Extra \ <br />Water <br />Title <br />L <br />Soap and Water <br />a copy of this application in <br />t the booth at all hours of <br />— —— ——j prior to <br />Date <br />] <br />7 <br />Rinse Water <br />IlJ-Waler supply dispenser with warm water at a minimum of 100T (l.e. 5-20 gallon container with spigot). <br />0<5ne separate tub (bucket or basin) for the collection of rinse/wastewater. <br />L^aper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation: <br /> __________a <br />UHoilo2 HaZ0lt0n AvGnile I Stockton. California 95205 | T 209 468-3420) F 209 464-0138 | www.sjqov.orq/ehd <br />06/19/19 Pago 8 of 11 TEMP EVENT APR <br />gutl^on^ for -P* —■ rinsing and one for a bleach <br />LJ Detergent, bleach, and wiping cloths (cleaning towels). <br />U Tub to store wiping cloths in bleach solution. ' <br />providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />All food vendor booths are subject to inspection. Please make l ~ " <br />preparation for this event. A copy of this checklist must be in t;.„'U/v«. ai ci, <br />preparation, and operatlomRelurn original to festival coordinator three weeks <br />chests ^Refrigerator <br />f ’Refrigerated truck Q ,ce balh and tubs <br />□ Other (specify) <br />Soap d(p«nior J _____ <br />I nicaUi < - <br />■•■■'I I <br />Cultmg Hoard