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Environmental Health Department <br />10. <br />OR <br />12. <br />13. <br />•important** <br />14. Completed by:Signature <br />PMtrHmlTtMii <br />Ice Cooter <br />Health Permit | <br />11. <br />OMbaga <br />Can <br />»B—>« !■< I <br />MMhawMTtar I —[ <br />Booth nutiMon <br />Cencrata.AieMI <br />nyMod.oraTaip< <br />SAN JOAQUIN <br />COUMTV <br />1 ^FQffoJd***** potenti-,y Wow <br />OlcacheetB □Relhgemtor <br />O Refrigerated truck lee bath and tube <br />D Other (specify)____________________________________________________ <br />Al food vendor boctha are subject Io Inspection. Please mete a copy of this appfcafcn in <br />preparation for this event A copy of this checkist must be m the booth at OH hours of <br />prepwotton mi operation. Ratom original te foettyai cQOriltistof throe weeks Pffor.to <br />bate r <br />teSS&Haw’tonAvanuel <br />p 2094644)135 I ***^1®^Stockton,CUfomia96208| T M9468-34201 <br />FB0a • w •» <br />for the aanitefy cleaning of food preparation utensil <br />©Three deep tubs (basins 6-8 Inches minimum), one for soepy water, one tor rinsing and one tor a bieech <br />•wAion (one tabtespoon of bieech per gallon of water). <br />S Detergent, bieech, and wiping cloths (ctoanlng towels). <br />S') Tub to store wiping cloths In bleach solution. <br />I am providing the foltowing for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Water supply dispenser with warm water ata nWiimum of 100*F(l.a. 5-20 gallon container with spigot). <br />Ona separate tub (bucket or besin) for the ooBection of rtneofwastewatsr. <br />-S^Psper towels and pumo-rtvle soap contalnar. <br />Names of responsible persons to be present in booth during alt hours of operation: <br />Title <br />WI(M <br />r IMMMWMV