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asaEEEnss™-— <br />Environmental Health Department <br />10. <br />1 <br />12. <br />13. <br />“Important** <br />14.Completed by: <br />IHealth Permit <br />P»wr ItwxiTo-wi* <br />CuUng Bon) <br />Prupane Stove <br />fropa/M Tank <br />Fre E>*nQutn®r <br />209 464-0I 38 | v5.w.v s/gev org/eh'd - <br />Paga 8 cl 11 <br />-7 <br />S<Mpm4WiWr <br />'P^Vater supply dispenser with warm water at a minimum of 100T (i.e. 5-20 gallon container with spigot) <br /> One separate tub (bucket or basin) for the collection of rinseAvastewater. <br />Paper towels and pump-style soap container. <br />She™ wOultog <br />Oib <br />$ G* >l»xl .n*. <br />Voumakv Coc^nar <br />Garbage <br />Can <br />I w«*r tar <br />Itanng -org doM <br />SAN JOAQUIN <br />C O: ' I . - \ <br />Title <br />1U <br />RmwWMer <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />! Ice Cooler <br />t un kx Dtji l > caj r».K be I <br />UonO « nTx-t cilottbe I <br />1868 E. Hazelton Avenue I Stockton. California 95205 | T 209 468-34 2 0 | F <br />UOIW P^sc/lt . <br />(W1V19 •. <br />All food vendor booths are subject to inspection. Please make a copy of this application in <br />preparation for this event. A copy of this checklist must be in the booth at all hours of <br />preparation and operation. Return original to festival coordinator three weeks prior to <br />this evoptt / // i / <br />Date <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 /> Ice chests ^Refrigerator <br />^Refrigerated truck ice bath and tubs <br />Other (specify) 'hucK <br />'LxBi Prodding the following Hems within my booth for the sanitary cleaning of food preparation utensil <br />JScThree compartment sink. <br />Q 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 />Fl Detergent, bleach, and wiping cloths (cleaning towels). <br />O Tub to store wiping cloths in bleach solution. <br />XJ <br />Booth must be on <br />Concrete, Asphalt. <br />Plywood, or a Tarp. <br />a® <br />Names of responsible persons to be present in booth during all hours of operation: <br />is evoryu < / / <br />1 Signature <br />5-20 G* <br />r- Kenl wVi WMor <br />[ Soipdwwr I ----------- \ <br />°1s