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Environmental Health Department <br />12. <br />Ion container with spigot). <br />13. <br />“Important** <br />14.Completed by; <br />Title <br />Health Permit <br />Pap«r Hund Townfa <br />Soap dlsponinf <br />CuttkiQ Board <br />Propann Slow <br />Dl«oen hhd Wa:«r <br />Piro OttnovObcf <br />Page 8 of 11 <br />8l«nx> w/Ch«ff|no pun <br />Extra <br />V.'itef <br />F 209 454-0138 | www.sjcehd.com <br />TEMP EVENT APP <br />Garbage <br />Can <br />Booth must be on <br />Concrete. Asphalt, <br />Plywood, or a Tarp. <br />/0 Water supply dispenser with warm water at a minimum of 100T (i.e, 5-20 gain <br /> One separate tub (bucket or basin) for the collection of rinse/wastewater. <br /> Paper towels and pump-_$tyle soap container. <br />&fra la Dto* s Aood CantniMfs must bt <br />ttorad e Mcfioi ofrofttv o^unai <br />6 Gal Hana woeti <br />Wutrwaiar Co-it*ln»r <br />MQ Oal. <br />Hand wash Wiilor <br />S«nlllzar buckat- <br />blaoch A water for <br />Btonnc wiplno doth* <br />z*?1" <br />hr <br /> j Propane Tank LX <br />i 'V 1 it-.Z <br />SZn for soapy waler' one for ri"si"9 and a bleach <br /> Detergent, bleach, and wiping cloths (cleaning towels). <br /> 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 />uouin. j <br />ujo ii n o <br />Names of responsible persons to be present in booth during all hours of operation: <br /> ---------------- _____ _ ______ ________________ <br />3? SL;b''eCt 10 pte3SS make'Fcopy of this application in <br />^^■Ha2e,tonAvenuel Stockton, California 952051 T 209 468-3420 | <br />07/3/17 Page 8 of 11 <br />w <br />Ice Cooler <br />Soap ana Watar <br />preparation for this event. A copy of this checklist must be in the booth at all hours of <br />th^event Operation' ^etur"-0riflinalj0 festival coordinator three woeks prior to <br />Signaturfc^^ Title Dafe 7 ' <br />11’ □ Three^mpad^^^^ b°Oth Sanit3ry CleaninS off00d PreParation utensil <br />OR <br />fffASANJOAQUIN <br />-----COUNIT*— <br />■“ Greatness grows- h^re. <br />''iws »“* “•“«> *“■— <br />Ice chests Refrigerator <br /> Refrigerated truck Q ice bath and tubs <br /> Other (specify)