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■‘ I <br />Environmental Health Department <br />10. <br />OR <br />12 <br />0' <br />13 <br />“Important" <br />Signature <br />Health Permit PjoerHjMTcxMW <br />| PTpp^-rarP <br />Booth must be on <br />Concrete. Asphalt, <br />Plywood, or a Tarp <br />I BW»cn <br />G«rD»B« <br />Can <br />Sar*=Bf <br />far <br />SUrro •a./Cru.rTinQ <br />Oich <br />■53—] J <br />• ..b <br />y tee Cooler^ <br />1 Cuartg Board <br />S'i-.o 1 <br />0^01 __.1 . ---- <br />nvn.w^. ] {~ ] <br />QEp '---------„ -r, ^■1 sua,. <br />;,.. ; ■■■■■x.; ....^<z..............-,■ ;<■ ;?.,, <br />□'Three compartment sink. <br /> 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 /> Detergent, bleach, and wiping cloths (cleaning towels). <br /> Tub to store wiping cloths in bleach solution. <br />1 am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Water supply dispenser with warm water at a minimum of 1OO‘F (i.e. 5-20 gallon container with spigot). <br /> One separate tub (bucket or basin) for the collection of rinse/wastewater. <br /> Paper towels and pump-style soap container. <br />______ <br />.■> (bl ----------------------------------------------------------------------------------- <br />14. Completed by. <br />All food vendor booths are muS'Sin “e^ooS'V all hours tf <br />this event Q y_( <br />---------- Tide ~ Date <br />I SIC 0»i I <br />I HandvoshWsU^ | <br />| So»poop«n»< | --------1\ <br />SAN JOAQUIN <br />- COUNTY----- <br />C">73tr--5 (jr.-,,v h.- <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />45CF (if food is used the following day, maintain below 41 °F temperature). <br />S'lce chests 0 Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify)------------------------------------------------- ----------------------------------------------------- <br />11 lam providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />i