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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />13. <br />"Important" <br />2.3JCompleted by:14. <br />JHealth Permit Paper Hand Towels1dCuttinq Soard a Bleach <br />Propane Stove <br />Bleach and WaterRinse WaterSoap and Water <br />Fire Extinpuisher <br />Sterno w/Chaffing <br />Dish <br />Booth must be on <br />Concrete. Asphalt, <br />Plywood, or a Tarp. <br />Title <br />5-20 Gal. <br />Hand washWater <br />Sanitizer bucket­ <br />bleach & water for <br />stonng wiping cloths <br />Extra <br />Water <br />- - I T 209 468-3420 | F <br />page 8 of 11 <br />I <br />s <br />i <br />I <br />r-. <br /> 5 Gal Hand wash - <br />Wastewater Container I <br />■ ■' ■; event. <br />L/| • • - ---------- <br />preparation ahd operation^ <br />this event. [ ] / <br />Siglfatu^ <br />r" <br />.XiIce Cooler <br />life <br />sanitary cleaning of food preparation utensil <br />1868 E. Hazelton Avenue | <br />EHO 16-02 <br />rtviivi0 <br />209 464-0133 | <br />| Soap dispenser j <br />K- <br />Khk <br />Extra W Sags « Food Comakers must t>o 1 <br />stored 6 inches ott ol the ground!| <br />Stockton, California 952051 <br />I am providing the following items within my booth for the <br /> Three compartment sink. <br />H^Three deep tubs (basins 6-8 inches minimum), one <br />'' solution (one tablespoon of bleach per gallon of water). <br />EkOetergent, bleach, and wiping cloths (cleaning towels). <br />zQ Tub to store wiping cloths in bleach solution. <br />I am providing ihe following for odegoate hand washing facilities, but separate from utensil wash within mv <br />booth: <br />QWate, suppl, dispenser with warm water a. a minimum of WOT (i.e. 5-20 gallon confainer wifh spigot). <br />0 One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Q Paper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation: <br />Garbage <br />Can <br />for soapy water, one for rinsing and one for a bleach <br />« food vendor booths are subject to “Ssrhe’in’ XXS'S 2 <br />preparation ter this event, A^py * <br />'^-1- <br />“ Date <br />SAN JOAQUIN <br />------COUNTY------ <br />Great/ ss grans iiere. <br />I am providing the following sold temperature control for the coid holding of potentially hazardous feeds below <br />«-F?f food is used the following day. maintain below 41 -F temperature). <br />Q Ice chests Refrigerator <br /> Refrigerated truck lce bath and tubs <br /> Other (specify)_