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----KUKMtMin <br />Environmental Health Department <br />11. <br />OR <br />12. <br />13. <br />“Important** <br />Completed by:14. <br />Health Permit <br />I CUtnQBOJnj | <br />Propma Siova <br />Ice Cooler <br />1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-34201 F 209 464-0138 | ww’8J“J‘;!.com <br />TEMPEVENTAPPPagaSof 11EHO 16-02 <br />07/3/17 <br />E»tni tea Bv t food Cw/Mnan muU be <br />Horn t Mitt tit at »e gmuna <br />6 Oil Hand wash <br />V/attawalar Ccniakwf <br />Garbage <br />Can <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Slamo w/Chafflno <br />CUh <br /><7 Dice bath <br />StndtarbucJiar- <br />bTaichlWilttlw <br />(tortnQMpinadoVii| Baadi <br />I Propane Tar* <br />■) <br />RkwaWMar <br />0 <br />% <br />10. <br /> mfeooaoi- 7~/- \ <br />SoapaniVMar II RkuaWMar BkachandWMar <br />SANJOAQUIN <br />•’ S' 'l -----COUNTY------ <br />n«»v'*kV Grcolncis yroivs heic. <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />4^*F (if food Is used the following day, maintain below 41*F temperature): <br />[jiIce chests Refrigerator <br /> Refrigerated truck Ice ba|l) and tubs <br />G?(Other (specify). <br />ial to festival coordinator three weeks prior to <br />Title Date <br />I M0G< I <br />r- I HandwaiAWatar | <br />| 6flap<Hpanw| ----------A <br />Names of responsibly persons to he y- <br />/v- I nroExllngAhar |m <br />irsonsjQybp pjes^nt inhoolh ^dyring^^our^ o^op^r^loi^ <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 orlgtfii <br />A/ Jr <br />Signature 7 <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil / <br /> Three compartment sink. <br /> Three deep tubs (basins 6-8 Inches minimum), one for soapy water, one for rinsing and ode for a bleach <br />solution (one tablespoon of bleach per gallon of waler). * //A / / <br /> Detergent, bleach, and wiping cloths (cleaning towels). /,/frt. Vi ' clri/t'U' <br /> Tub 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 />booth: <br />[pf Water supply dispenser with warm water at a minimum of 100’F (i.e. 5-20 gallon container with spigot). <br />tS One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Paper towels and pump-style soap container.