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Environmental Health Department <br />11. <br />for rinsing and one for a bleachOR <br />12. <br />13. <br />Completed by:14. <br />Health Permit <br />Pnpor Hand Tow®/« <br />Soap dltp«niar <br />Cutllno Board <br />BtoachPropane Sieve <br />Propane Tank <br />Rlrwo WalerSoap and Water <br />Fire Ejdlnpuhher <br />IIce Cooler <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 I www s|qov oro/ehd <br />Pago 8 of 11 ’ temA EVENTSTEMP EVENT APP07l0\n024 <br />A_______ <br />Bleach end Water <br />I <br />I <br />I <br />Stomo w/ChelHno <br />Olah <br />S-2O Gal. <br />Hand with Waler <br />Garbage <br />Can <br /> Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />6 Gal Hand wait <br />Waatowaier ConUlnar <br />SarJlfaer bucket­ <br />bleach & water lor <br />aiming wiping cMh* <br />I <br />I <br />I <br />X I <br />i <br />J i <br />( Exira \ <br />Water <br />s Water supply dispenser with warm water at a minimum of 100°F (l.e. 5-20 gallon container with spigot). <br />0 One separate tub (bucket or basin) for the collection of rlnse/wastewater. <br />Exire/ceflepadPoodConleJrMramuafbd K <br />aktred 0 Inc/iea o/Toribe ground! fl <br />0 Paper towels and pump-style soap container. <br />Names of responsible persons to be present In booth during all hours of operation: <br />Susan Lapena and Romeo Yraola <br />SAN.JOAOUIN <br />_ f ------COUNTY------- <br />-'t/Grcofness grows here. <br />10. I am i <br />**lmportant** <br />El Three deep tubs (basins 6-8 Inches minimum), one for soapy waler, one <br />solution (one tablespoon of bleach per gallon of water). <br />S Detergent, bleach, and wiping cloths (cleaning towels). <br />s Tub to store wiping cloths In bleach solution. <br />I am providing the following for adequate hand washing facilities, but separate from utensil '.wash within my <br />booth: <br />Ss SSEsSSiEssIs: <br />this event Owner 8/26/24 <br />1 Signature Title Date <br />(MM <br />: provMlna'the’folfowIng co'ld’temperature control for the cold holding of potentially hazardous foods below <br />45*F (If food Is used the following day, maintain below 41 °F temperature;. <br />E) Ice chests D Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify) ................................. “ <br />I am providing the following Items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink.