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r <br />Environmental Health Department <br />PwcL toe/- <br />11. <br />OR <br />12. <br />13. <br />Completed by.14. <br />Health Permit P^NClMTaMb <br />| Proton* T«r* <br />SwoaMWM'r <br />HraBdk««MMr <br />Ice Cooler <br />I <br />tIodBswMtvdctfB <br />Garbage <br />Can <br />StamoWCMfina <br />a»h <br />WMtawOarCaiabw <br />Ii <br />1 <br />DiMdiMdWAr I <br />r <br />Booth must be on <br /> Concrete, Aspha*. <br />Plywood, or e Tarp. <br />Names <br />IrkfXnaxYvX <br />“Important** <br />MhmWMm I <br />Q <br />^-^^Slgnatuf^ <br />i <br />& A SMWOAQUINW-U; 1 ----COUNTY---- <br />\ ,* *!•«*' •' <br />''•»h i***' Grrofncit groivt here. <br />10. I nm providing the following cold temperature control for the <br />Efwater supply dispenser with warm water at a minimum of 1WF (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 />of responsible persons to be present In booth during all hours of operation: <br />Miradt tetes offoTiM F~i*_______F <br />1868 E. Hazelton Avenue | Stockton, California 95205 IT, 209 468-3420 | F 209 464-0138 | ^iemp event app <br />EHO1M2 <br />07/0V2OM <br />All food vendor booths are subject to inspection. Please make a copy °f this S <br />this event _/_to /Z } C^l^\2^ <br />Date <br />CuanoBowd | <br />PropwoStovo <br />cold folding of potentially hazardous foods below <br />45T (If food Is used the following day, maintain below 4IT temperature): <br /> Ice chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br />J30lher(specify)___^toCtto------------------------- -------- ------- ------——————— <br />larp providing the following Items within my booth for the sanitary cleaning of food preparation utensa <br />i/]Three compartment sink. <br /> Three deep tubs (basins 6-8 Inches minimum), one for soapy water, one for rinsing and one for a bfea <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 />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth:. <br />Title <br />MO GA <br />r- HwdvMhWMar