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Environmental Health Department <br />10 <br />11 <br />OR <br />12 <br />^0 Water supply dispenser with warm water at a mnmum o< 100'F (i.e 5-20 gaBon container with spigot) <br />separate tub (bucket or basin) for the collection of nnse/waslewater <br />13. <br />"Important— <br />Completed by <br />Health Permit <br />•Ur.l T«H <br />Su«D <>«»■' <br />I <br />fn I atmuttho <br />Ice Cooler <br />TtMPCVtNT APP <br />Scanned with CamScanner <br />v«aaiM<M e.riTM <br />tNMditaMvfcl <br />•tomg aor>» <br />tw-rn o <br />»2C Ga <br />amh *<Mr <br />Three deep tubs (hasns b-8 inches mmmum). one for soapy water, one for nnsing and one for a bleach <br />solution (one tablespoon of bleach per gallon of wafer) <br />—-0 Detergent, bleach, and wiping cloths (cleaning towels) <br />-0 Tub Io store wiping cloths tn bleach solution <br />I am providing the foltawing for adequate hand washing facihbes, but separate from utensi wash withm my <br />booth <br />I am providing the following items wrthm my booth for the sanitary cleaning of food preparation utensil <br />Q Three compartment sink <br />persons to be present m booth during all hours of operation <br />________________ <br />Gartiago <br />Can <br />I am pmvxkr^j the folowing cold temperature control for the coM hoMng of potenhaly hazardous foods below <br />45'F (if food is used the following day, maintain betow 41T temperature) <br />'^0lce chests Q Refrigerator <br /> Refrigerated truck ( 1 ice bath and tubs <br />Q Other (specify) <br />Names of responsible <br />MHHH <br />Booth muti be on <br />Concrete Asphalt <br />Pty^ood ex a Tarp <br />SAN JOAQUIN <br />— C O U N T v <br />I <br />s««r •rrS <br />r7 <br />A copy of this checkfest must be m the booth at all hours of <br />Return original to fofthffl coordinator three wffki poor to <br />i\* rv f* (t t£- J 2 <br />Title Date <br />All food vendor booths are subject to inspeebon Ptease make a copy of this application m <br />preparation for this event, <br />preparation and operation <br />thie event- . <br />Signature <br />C*■ «.• On-—»|»|’» K <br />•aorau • nerv* oX uZ Vw R <br />1B66E Hazelton Avenue | Stockton, California 95205 | T 209 468-34201 F 209 464-0138 | www sjgov org/ehd <br />EHO 1602 n*Q» 6 c« 11 <br />0&7V2023