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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />Q Paper towels and pump-style soap container. <br />13. <br />**lmportant“ <br />14.Completed by: <br />Signature <br />Health Permit <br />PapwHixITwh <br />SoxKlnpcnsc* <br />CtflncDoivd <br />Prupano Skwo <br />I JI— <br />[W«adi ord Vliif <br />Ice Cooler <br />Hazelton Avenue | Stocklon, CaWomia 95205 | T 209 460-3420 | F 209 464-0138 <br />5 GjI‘land r*»>li <br />WiKUoxiM CmtarwiC«<ra fco Ojuj I Tvxt^unnmxlba <br />Samur/ h>Kkc:- <br />Woadl 4 Miter lor <br />•tonns "t'O'J rfcdu <br />0 Water supply dispenser with warm water at a minimum of 100’F (i.o. 5-20 gallon container with spigot). <br /> One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Boo:h must bo on <br />Concrnlo, Asphalt, <br />Plywood, or a Tarp. <br />i <br />| www sjgov.org/ehd <br />TEMP EVENT APP <br />1868 E <br />EHD IGO2 <br />UVIWIO <br />I am providing tho following cold temperature control for the cold holding of potentially hazardous foods below <br />45"F (if food is used tho following day, maintain below 41’F tempeiaturo): <br /> Ice chests Refrigeralor <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify) ___ ______________________________________ <br />Garbage <br />Can <br />Sterna wt'Joilrg <br />Doh <br />SAN JOAQUIN <br />-----COUNTV— <br />Title <br />All food vendor booths are subject to inspection. Please make a copy of this application in <br />preparation for this event. A copy of this checklist must be in tho booth at all hours of <br />preparation and operation. Return original to festival coordinator three weeks prior to <br />this event <br /> <br />Date <br />II / <br />J Eo.>p nnd WoW <br />lam providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />fU Three compartment sink. <br /> Three deep tubs (basins 6-8 inches minimum), one for soapy waler, one for rinsing and one for a bleach <br />solution (one tablespoon of bleach per gallon of water). <br /> Detergent, bleach, and wiping cloths (cleaning towels). <br />U Tub to store wiping cloths in bleach solution. <br />Persons t0 b0 Pf0sent in booth during all hours of operation: <br />I) am providing the following for adequate hand washing facilities, but separate from ulensil wash within my <br />2__, <br />Ibnio Watci I <br />/ Ert4 \ <br />| L <br />3 u 0.