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Environmental Health Department <br />10 <br />11. <br />OR <br />12 <br />’ »oao contatner <br />13 <br />“Important** <br />14 Completed Dy <br />Signature Title Date <br />Health Permit <br />Si2h«e <br />! A~i»Bre» I ant <br />IlMdl *« Wattf <br />Ice Cooler <br />w*ZW <br />c <br />5- X Gsi. <br />Hand wests'Ataicy <br />Saniaer&vgiac <br />weary, fc wjtm for <br />X] WfiMer supply disptsnsor with warm water at a mmsmum of 100’F fi e 5-20 ga«on container wlfih spigot). <br /> One separate tub (bucket or Pawn) lor the collection of hnsafwaetewater <br />I am providing the foSowmg for adequate hand washing faciiSbes, but separate from utensil wash witfun my <br />booth <br />SCtiMwidwiBV. <br />r^nrMi/.mw CuWw <br />Gamaae <br />Can <br />I am pcovkSng the following ccM temperature control far the co« holding of potentially hazardous foods below <br />45’F (If food <5 used the fotiOwmg day. maintam below 4TF temperature); <br /> Ice chests Rofogorotor <br />fl Refrigerated truck Q Ice bath and tubs <br />S Other (specify j. <br />SAN JOAQUIN <br />- -county <br />Srt?Xi are V^'Kr j <br />r <br />£3 Paper towels and pur <br />Names of rcspcnsiibto persons lo be present m booth during all hours of operation <br />" -k<ch fqtc) 7^ <br />All food vendor booths are subfect to inspection Please make a copy of the appitcaaon in <br />preparation far th* event A copy of this checklist must be In foe booth ait aS hours of <br />preparabon and operator Rgfam prigirHil to fwrtlviri coordinator force wppks prior to <br />lam praviiSng foe following items within my booth for the sanitary cleaning of food preparation utensil <br />Three compartment s«k <br />’S Three deep tubs (basins 6-8 fache# rwwnum), one far soapy water, one for rinsmg and one for a bte&ch <br />solution (one tablespoon of bieadi per gallon of water). <br /> Detergent, bleach, and wiping cloths (cleaning towels) <br /> Tub to store wiping cloths in bleach solution <br />Ab> ♦««» A Omiwsmt •*»«■ Is* B <br />sirswtf« e» erniw tpatMtr' R <br />I &3«! I <br />188SE Hazelton Av^ue | StocMon. California &&2O5 | T 209 463-34201 F 209 464-0138 ; www sjtxhd.com <br />Lttt>1GC3 R*»G=fTI TFMPFVrafTAPP <br />Booth must tw on <br />Concrete Asphalt <br />Plywooe. or a Tw <br />___________/