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L 5,11.qua mrCh.l..,,,) <br />DV, <br />I Health Permit <br />i _j <br />Ice Cooler I <br /> i <br />[ P re 1 C -,1,4•1 ,•• I <br />L s,...,•^41./dPer <br /> L <br /> f/ <br />R 'SO VVP. Garbage <br />Can <br />11 f n.s ice &II il i 00../ C4.,10.1,3 <br />J',.•4 0 .0401 6,I a r^* g- cvoe <br />Hao:1 I <br />54.,44 <br />14•40,I makdo 1. <br />wty,,,i poso t iolfn <br />&Nap 1.144,W. <br />:3 <br />Booth mu-sr be on <br />Commie, Asphaq. <br />Ptyrroad, or a Tarp <br />Cult.ny Bord-1 — <br />Propan• Stave <br />P ,OP ,wit val <br />4S029759-C4D3-413D3-13187-399AC6821390A Joel <br /> <br />SAN JOAQUIN <br /> Environmental Health Department <br />N <br /> <br />10 I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />46T (if food is used the following day, maintain below 41*F temperature) <br />D Ice chests n Refrigerator <br />D Refrigerated truck 0 Ice bath and tubs <br />FI Other (specify)._ ""•-te;,, <br /> <br />11 I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />'ff.] Three compartment sink <br />OR Three deep tubs (basins 6.8 inches minimum), One for soapy water, one for rinsing and one for a bleach <br />solution (one tablespoon of bleach per gallon of water) <br />D Detergent, bleach, and wiping cloths (cleaning towels) <br />U Tub to store wiping cloths in bleach solution'. . <br />12 I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth <br />D Water supply dispenser with warm water at a minimum of 100*F (Ie. 5-20 gallon container with spigot) <br />D One separate tub (bucket or basin) for the cdlection of rinsetwastewater <br />D Paper towels and pump-style soap container <br /> <br />13. Names of responsible persons to be present in booth during all hours of operation <br />HITIPC 1 J cy,-.) <br />1 c-k te'cr-r Aloft <br />**important" All food vendor boo hs are/sub:0cl to inspection. Please make a copy of this application in <br />preparation for th ever copy of this checklist roust be in the booth at all hours of <br />preparation and turn original to festival coordinator three weeks prior to <br />14. Completed by <br />Title <br />CL'-lc' <br />Date <br />1 3 ./ E :1:3 7Pitnn Avr•nlif I St( cM on ::11.(nroci "1:2n5 I T 700 468-34201 F 209 464-0138 WV,AV sigOv Org'ettd <br />1LUPEV(J1APP <br />19 <br />haps grxxile corn/maiVutallab.rtndrorpliiinbozNVNAKKXwvpHbriDDCAGFEirjklbOHnVRVPraWbpFkl vAArnorJF1031/PVVzsVorBRRI IiIrGInDKwf