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Environmental Health Department <br />10 <br />11. <br />OR <br />12. <br />3 Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with sp»got). <br />3One separate tub (bucket or basin) for the collection of rinse/waslewater. <br />OCPaper towels and pump-style soap container <br />13 <br />••Important" <br />Completed by14. <br />Signature <br />Health Permit <br />P«pw Tc<Mtt <br />rrcpvw SItm <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 />5 <>4l >»■■«! 44«ri <br />ISKr***- ContitK <br />Garbage <br />Can <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth <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 />C^lce chests Refrigerator <br /> Refrigerated truck f^ce bath and tubs <br /> Other (specify)_____ <br />Eixkas <br />< aoro >iw <br />Mcrw^ dcrw <br />Booth must be on <br />Conctere. Asphs* <br />Plywood, or a Tarp <br />AH food vendor booths are subject to inspection Please make a copy of this application m <br />preparation for this event A copy of this checklist must be m the booth at all hours of <br />preparation and operation Return original to festival coordinator three weeks prior to <br />thrsj^vent. <br />Names of responsible persons to be present m booth during all hours of operation <br />KRISTA LUCERO <br />SAN JOAQUIN <br />COU NTY <br />Ice Cooter <br />I — <br />OWNER <br />Title <br />3/13/26 <br />Date <br />Puxane T*r»I <br />Soati arKiWkix <br />_z <br />1858E Hazelton Avenue | Stockton Cairiornia 95206 | T 209 468-3420 1 F 209 464-0138 i zavw sjeend com <br />EMO 16-02 Pap»80f11 TEMP EVENT APP <br />07/3/17 <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink <br />$-20 (Mi <br />WO. <br />(Hratb uro WMar ____ <br />I lc* Aagi A footl Centumn •nutl I. <br />I Mjetl t irtfioa at d fte orujie’ j