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Environmental Health Department <br />11. <br />OR <br />12. <br />13. <br />•‘Important4* <br />11\14.Completed by: <br />Signature <br />Health Permit <br />Paper Unnd Tcv.rl: <br />Propm# Skrjft <br />SI <br />FV-0 E«Hnoiisher <br />Ice Cooler <br />PflQf. a at 11 <br />5-50 Gel. <br />Hand wash Wilor <br />Garbage <br />Can <br />SMliier bucket- <br />Naaca iwaiorfcr <br />itoing wping dc'hj <br />Exlr^ In Oogi S Zbod Conithcrs nwl ba SlCrdBlocnu DnoHTieQrmrd'. <br />Stemo wXJianiAg <br />CXih <br />5 Cal lt<v>d ACi-'i <br />WailcATilcr Cor taliar <br />Biesch <br />Title <br />1 am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: , ; .A / 4 <br /> Water supply dispenser with warm water at a minimum of 10CT (i.e. 5-20 gallon container with spigot). <br /> One separate tub (bucket or basin) for the collection of rinseAvastewater. <br /> Paper towels and pump-style soap container. <br />CWJrig Hoard 1 <br />■' ?:% SANJOAOUIN <br />-------COUNTY------ <br />Greatness Ijrows here. <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />45°F (if food is used the following day, maintain below 41 °F temperature): <br /> Ice chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br />Fl Other (specify) _ <br />lam providing the following items within my boot!) for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br /> fhree deep tubs (basins 6-8 inches minimum), ono for soapy water, 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 /> Tub to store wiping cloths in bleach solution. <br />eh??C-o2 Hazelton Avenus 1 Stockton, California 95205 ] T 209 468-3420 | F 209 464-0138 | wvrw.sjcehd.com <br />amn? pnofi ” o111 Te mp event app <br />'rsT.'''.. <br />TO’. <br />10. <br />S«pindW*«- RliwiWjtar | <br />f <br />j Soap dtpeaier | ---------- <br />Boolh must be on <br />Concrete. Asphalt. <br />p|ywocd-or a Ta,p- <br />Names of responsible persons to be present in booth during all hours of operation: <br />____i rz> THS- Al R-eug^ <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 the booth at all hours of <br />preparation and operation. Return original to festival coordinator three weeks prior to <br />this event. ------—— _ , <br />Date <br />Propano Tun* , ‘ .. .—K