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J <br />Environmental Health Department <br />10. <br />|Xj|iX 11. <br />OR for soapy water, ooc tor rinsing ar*l one for a bteacti <br />H One separate tub (bucket or basin) for the collection of rinso/waslewater. <br />f~l Paper towels and pumprStyfp soap container. <br />14.Completed by: <br />roper liand Tom>« <br />SoapdtaponMr <br />Cucdna Boenl <br />Propono Stove <br />ui F <br />Propane Tank <br />.^7 tBaach araj Wrier <br />•fc'PageSofll TEMP EVENT APP <br />&en*rar buUiar- <br />Mead) & water for <br />atodng vripng ckita <br />Erin kt Bagi X Food Ctntatan not ba <br />tionddMttoKaflhtffxxmdl <br />Storno (TCtiarang <br />UeV> <br />SGolliandwMh <br />Waslowaltr CorMner <br />Garbage <br />Can <br />*1 <br />,f)f) W\O<>AX1 <br />Signature <br />Booth must be on <br />Concrete. Asphalt <br />Plywood, or a Terp. <br />I am providing the <br />booth: <br />SS Wator supply dispenser with warm water at a minimum of 100oF (i.o. 5-20 gallon contamor with cpigot). <br />Health Permit <br />SAN JOAQUIN <br />i < HIM’ V <br />_________ <br />I <br />Soop»<»JW»Ur <br />Names of responsible persons to bo present In booth during all Iwurs of operation: <br />V'T'-r; ,....... T'"- T~'~ ---------- <br />1 ■______________________________________________________________________>__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ <br />All food vendor booths are subject to inspection. Please make a copy of this appfcation h <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 />Titl0 Dato <br />yrv. 1^. I Fr. FrfjnouMwr <br />pee Cooler j ! <br />5 20 GaL <br />Y* ltondw»ViW«to< <br />I ----- \ <br />mF Jik—v <br />. 13.? _ ... _ <br />“Important** <br />1868 E. Hazelton Avonuo | Stockton, California 952O5J 1^209 468-34201 F 209464-0138 | www.sjgov.org/ehd <br />oflftaw . ' <br />IT <br />Rmcaater I <br />0 <br />HD Ice chests |. | Rohigomlor <br />M Rolrkfonihxl truck I I l<x» ImHIi amt tulm <br />M Olhw (afwcily).---------------------------------------------------------------------------------------------------------------------------- <br />M/A 12. <br />I am providing ttH> following ifoms wllhin my Ixxrth for lh<. sanlfoiycfoanlnfl of food propwatiofi utwwli <br />f_| Ihroo comportment sink. <br />n Three dtreji tubs (basins (MJ Inches minimum), or»o <br />solution (oik* tat»fospoon of Ueach per gallon of waler) <br />□ Detergent, bleach, and wiping cloths (donning towels). <br />□ Tub to store wiping dollrs in bleach solution. <br />following for adequate hand washing facilities, but separate from utensil wash within my