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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />13.Names of responsible persons to be present in booth during all hours of operation: <br />**lmportant** <br />14.Completed by: <br />Signature Title Date <br />Health Permit <br />Paper Hand Towels <br />Soap disponsor <br />Cutting Board <br />Propane Stove Bleach <br />Rinse Waler <br />Ice Cooler <br />Page 8 of 11 <br />Garbage <br />Can <br />Sanitizer buckot- <br />bleach & water for <br />storing wiping cloths <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Stemo w/Chafflng <br />Dish <br />5 Gal Hand wash <br />Wastewater Container <br />□ Th^Xart “t'6™ WitHn my b0°th ,Or ,he Sani'ary Clea™n9 °f food P^ration utensil <br />Propane Tank <br />l.f/Soap and Water <br />i <br />□ Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />□ One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />□ Paper towels and pump-style soap container. <br />5-20 Gal <br />y Hana wash Water <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />sitssi" r, preparation and operation. Return original to festival coordinator three weeks orinr to <br />this event. ---------- -------- <br />SAN JOAQUIN <br />------COUNTY------- <br />Grentness ^rows here. <br />1 “ <br />□ Ice chests q Refrigerator <br />□ Refrigerated truck Q |ce bath and tubs <br />□ Other (specify) <br />I <br /> z Extra Ico Bags & Food Containers must be | ! <br />-------- --------------- stored 6 inchas off of the ground! i <br />Hazelton Avenue 1 stockt°n. California 95205 | T 209 468-3420] F 209 464-0138 | www.sjcehd.com <br />07/3/17 Page 8 of 11 TEMP EVENT APP <br />Slul^o^one^ablespoon^f bleach^e^gaTon ofUwater)ne rinSi"fl a"d <br />LJ Detergent, bleach, and wiping cloths (cleaning towels). <br />LJ Tub to store wiping cloths in bleach solution.