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I am10. <br />11.bleach <br />OR <br />12. <br />5-20 gallon container with spigot) <br />13. <br />''Important*’ <br />Completi14. <br />Health Permit Paper Haf« Toweta <br />Bleach <br />Propane Stove <br />tr <br />Fire Extinouishw <br />I <br />Stemo wCrWBnO <br />Dish <br />5 Gal Hand wash <br />Wastuwatar Container <br /> Three compartment sink. <br />^ree deep tubs <br />Extra /co bugs & > ood Cwilanors must tw <br /> stonxl 6 mcnos off o/the ground! <br />Garbage <br />Can <br />SantUzor tJuctet- <br />bleach* wear for <br />storing wiping dom» <br />Booth must be on <br />Concrete. Asphalt. <br />Plywood, or a Tarp. <br />/O\ <br />Water <br />■ - <br />MM <br />Signature <br />_z <br />Soap ano Water Rinse Wau>r <br />Soap dispenser <br />_________________________ <br />/ A <br />Ice Cooler <br />Environmental Health Depai u <br />Please make a copy of this application <br />must be in the booth at all hours ot <br />r three weeks priorto <br />Date <br /> <br />I Propane Tank <br />Bleach and Water I <br />SAN JOAQUIN <br />’ ------COUNTY------- <br /><«■ Greatnctt grows here. <br />0 behests □Refugee <br /> Refrigerated truck Ice bath and tube <br /> Other (specify)—--------------------------------------- <br />1868 E. Hazelton Avenue | Stockton. California 952051 T 209 468-3420 | F 209 464-0138 | w™ <br />EHD 16-02 <br />Ofi/IWIfi <br />— - - ■ • <br />I Cuttmp Board | <br />. cokt holding of potentially hazardous foods below <br />41’F temperature): <br />' bX.-r--' ’ ' <br />“• T~'.~ ~ J_________________ <br />XZZZ -—-T -I <br />booth: <br />QWater supply dispenser with warm water at a minimum of 100’F (l.e. <br />separate tub (bucket or basin) for the collection of rinse/wastewater. <br />[g'paper towels and pump-style soap container. <br />All food vendor booths are subject to <br />preparation for this event. A copy of this checklist <br />oreoaration and operation. Return original to tesw <br /> <br />Title/ <br />5-20 Gai. <br />r- I Hand wash Water