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Environmental Health Department <br />10 <br />11 <br />OR <br />■K?.o*ubon <br />1?. <br />Q Mipply dapemer wrth wiwm wnter al a of 100'F (I e !>-20 gaficn cnrtninrr xmjo<) <br /> One MJparnlr tub (txxrkH or ba-jin) for l/w coHcctiOn of rroeAMr^roMer <br />13. <br />••Important’' <br />Completed by14. <br />Health Permit <br />1 •ta—>W--»» <br />I <br />1 <br />Ice Cooler <br />G4 <br />M «»« <br />tia —i i Uawi <br />M.< • aaw «■ <br />«»*| e*i*» <br /> RctrigQfBtrd irutJi <br /> Other (H*c*y) _ <br />fyp f T>| on <br />Trtle <br />I am prwfdrx) the tofic^nq lor adequate tuind rntshmg focMlei but separate laxn iXcnvl roosh *«hn my <br />booth <br />I am prcvxloq the foUowvxj coM temperature control lor the cokl hoUog of putenttaiiy ha/artkxA foods betow <br />45‘F (I food K used the fnilowing day, mantas betoa 41T icmperalire) <br />chests RcfrTQerator <br />bath and tubs <br />tCMTMlMM* <br />W«»l ■— Ct—HP <br />Cartag* <br />Can <br />I am pruvklaK] the foitowinq items imUki my booth lor ihr sar^ary c^anmq (/ food prrpwalwn i/mst <br />O Tbme compartment sink. <br />0wch wxai t* on <br />Concntui JUptsMl <br />PryMocxiai a Tarp <br />SAN JOAQUIN <br />COUNTY <br />! 4^^ <br />Date <br />I avw < r«»«h <«• ar n» _______P <br />1868 E. Hazelton Avenue | Stockton. Caton.. 952051 1 209 468-34201 F 209 464-0138 | <br />07/010074 <br /> Three de%%» tubs (basim 6 8 Inches mrwmum) one for soapy nrafer. one far nrmnq and one lor a Urach <br />••oMiuri (iw*‘ labfaspoon pt blear h per gaaon c4 mWcr) <br />CTTfaterpcnr. bleach, and jgipihg Cfotf^jUtaPf^to>M»ET 22) <br />LJ 1 ub to More wiping cloths in bleach sofabon <br />1 <br />I I [ <br />^H^iper tow»‘h and pump style 5Mfi t ontwncr <br />Namos of responsiile persons to bo present in booth during a« bar. of opcrat*jn <br />r (a\va C cc I n, r Ov___________________________________— <br />All food vendor booths ace subject Io nspevten Please make a copy of th<s apptcaUxi rt <br />CX’epahibon for this event A copy of lhei ctWCklksl must be ci the tooth at all 1***^ <br />prepar a bon and <br />this <br />Si