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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />13. <br />14.Completed by: <br />Signature <br />Health Permit <br />Paper Hand TowelsSoap dispenser <br />Propane Stove <br />Bleach <br />* <br />Rinse Water <br />Ice Cooler <br />4 <br />Stemo w/Chaffing <br />Dish <br />5 Gal Hand wash <br />Wastewater Container <br />Extra <br />Water <br />Garbage <br />Can <br />5-20 Gal. <br />Hand wash Water <br />I www.sjgov.org/ehd <br />TEMP EVENT APR <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />Cutting Board J <br />All food vendor booths are <br />preparation for this event. <br />P", . <br />thiy event.M —- <br />Propane Tank <br />•-----------------------I <br />Bleach and Wafer <br />“Important**SAbject t0 'pspecfion- Please make a copy of this application in <br />______3 Us1 [2.^ <br />Title Date <br />Extra Ice Bags & Food Containers must be <br />Stored 6 inches off of the ground! <br />EHolo2HaZelt0nAvenUe| St°ckton, California 95205 I T 209 468-3420 | F 209 464-0138 <br />06/19/19 Page 8 of 11 <br />0Water supply dispenser with warm water at a minimum of 100T (i.e. 5-20 gallon container with spigot). <br />0JDne separate tub (bucket or basin) for the collection of rinse/wastewater. <br />0. Paper towels and pump-style soap container. <br />NX)?k? l^>ersons t0 be present in b00th durin9 a" houre of operation: <br />SAN JOAQUIN <br />COUNTY <br />7'^ Greatness grows here <br /> ice chests Refrigerator <br /> Refrigerated truck Q |ce bath and tubs N /f\ <br /> Other (specify)_ <br />Within my bOO,h ,orSan,,ar' Cteani"3 '“d Preparation utensil <br />for soaw water-one ,or rinsin9 and for ’ bl“ch <br /> Detergent, bleach, and wiping cloths (cleaning towels). /A <br />LJ Tub to store wiping cloths in bleach solution. <br />lam providing the tonowing for adequate hand washing facilities, but separate fap utensll wash my