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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />E Water supply dispenser v/ith warm water at a minimum of 100’F (i.e. 5-20 gallon container with spigot). <br />13. <br />“Important** <br />14.Completed by: <br />Health Permit <br />Pa;w Hi id Tcvica <br />S«iO dacern' <br />CirtSnq B:s-S aP:cr.anc Stove <br />Prop.irs Tj»Ji <br />Seip irsiwref arreV.eler Btcno »ra •.V»,u <br />■ Ice Cooler <br />:«ra <br />G3 One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />E3 Paper towels and pump-style soap container. <br />£ia» in £ roed CvJairvi muzl z« <br />6 inzhti cH e1 Or <br />Stemo wXt-jTrj <br />Ctsft <br />Garbage <br />Can <br />Si- <br />E ciSi £ *.K:: ta- <br />»:cn--; wX'-'S OStK <br />Booth must to on <br />Concrete. Asphalt <br />Ply/roco, cr a Tarp <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />S GaJ H»’.e •> J5.1 <br />WarcMaie' Cz<Urz' <br />SAN JOAQUIN <br />COUNTY <br />All food vendor booths are subject to inspection. Please make a copy of this application in <br />preparation for this event. A ccpy of this chccMist must be in the booth a! all hours of <br />preparation and operation. Return original to festival coordinator three weeks pr»«r to <br />this event. ' n / / . <br />.'j .-L <br />^TJate ' <br />i»-x> c»: <br />Water <br />I am providing the following cold temperature control for the cold holding of ootentially hazardous foods below <br />45eF (if food is used the following day, maintain below 41’F temperature): <br />ST Ice chests <br />Q Refrigerated truck <br />H Other (specify) <br />rn : V } \ <br />/ Title . <br />I am providing the following items within my booth for (he sanitary cleaning of food preparation utensil <br />□ Three compartment sink. <br />S’ 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). /z, „ f__ z- / - / <br />□ Detergent, bleach, and wiping cloths (cleaning towels). ’ f TTr <br />□ Tub to store wiping cloths in bleach solution. <br />136SE Hazelton Avenue I Stockton. California 95205 | T 209 468-34201 F 209 484-0135 I www.sjgov org/ehd <br />EHD IC-CZ Page S of 1i TEMP EVENT AFP <br />CSZISHS <br />_J. <br />/ "/ ^nature <br />□ Refrigerator <br />□ Ice bath and tubs <br />y j t*-? (, ■ a / /< / a e <br /><10 <br />Names of responsible persons to be present in booth during all hours of operation: