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Environmental Health Department <br />10. <br />12. <br />13. <br />‘‘Important** <br />14.Completed by: <br />Health Permit <br />Paper Hand TowbIs <br />Culling Board <br />Propane Stove Bleach <br />Soap end Water <br />Fire Extinguisher <br />Ice Cooler | <br />I i <br />I <br />I <br />Garbage <br />Can <br />Sarttiaor buckcl- <br />blcach E water for <br />storing wiping cloths <br />6 Gal Hand wash <br />Wastewater Container <br />5-20 Gal <br />Hand wash WaterStemo w/Charnng <br />Dish <br />Rinse Water <br />( Extra \ <br />Water <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />________________________i <br />IS within my booth for the sanitary cleaning of food preparation utensil11. lam providing the following item: <br /> Three compartment sink <br />OR <br />sU Siitelf <br />.•Mb <br />Propane Tank <br />Exira fco Bags t Food Conlalners must bo <br />stored 0 Incites Odd the ground! <br />| Soap dispenser | <br />jgljQoU^^rin^ll^ours of gperation: <br /> <br />subject to inspection. Please make a copy of this application in <br />preparation and operation. ™st be..in the booth at all hours of <br />this event. •'77^ <br /> <br />Signa ti <br />KI Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Paper towels and pump-style soap container. <br />Names of responsible persons to be present <br />_foSP -H r>. <\. \ a r <br />Return original to festival coordinator three weeks prior to <br />7-8^4= <br />Title Date <br /> Three compartment sink. <br />feon^b^jcr^ble^ch^^^^ 'Or S°aW and one for a bieaeh <br />^Detergent, bleach, and wiping cloths (cleaning towels) <br />IX[ub 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 />iJB SANJ04QUIN <br />> ------COUNTY------ <br />tjreotness groivs here. <br />(if food is used thefolbwlng day maintaTSw^rF POlen'ia"y hazardous (00cis b8l°W <br /> Refrigerated truck bath and tubs <br />O Other (specify) ' <br />U-: p*---------<¥-----------Zp -/I—1 I <br />Bleach and Waler <br /> <br />^Ha2elt0nAvenuel Stockton. California 95205 | T^ 209468-3420 | F 209464-0138 | vrww.sjcehd.com <br />07/3/17 TEMPEVENT APP