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Environmental Health Department <br />10. <br />OR <br />12. <br />"Important** <br />44. Completed by: <br />Signature <br />Health Permit <br />Pi,*.- Towite <br />ScjGdbpanMr <br />I dfii^EbCj! <br />T <br />Ice Cooler <br />TEMP EVENT APPPagsQof'il <br />&50 G£. <br />KaMwaVt Water <br />| Oteach <br />® Weter supply dtepenser with warm water at a minimum of WOT (i.e. 5-20 gallon container with spigot). <br />One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />&rt *» < Fbotf Coflte*wrai»utt tx <br />Swnow/Cnsnag <br />Cteh <br />bteachA Mterfer <br />tefiring wiping tic*u <br />Bcotn srost ba on <br />Concrete. Asphalt. <br />Ptywood, w a Tarp.o <br />[ •L'^~| i^^qj | <br />I &e>s \ <br />j VftOf S <br />SAN JOAQUIN <br />CCUMTV <br />ab <br />^Paper towels and pvmo-tfrte SMP container. <br />13. Names of responsible persons to be present in booth during aS hours of operation: <br />11. lam providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />O Three compartment sink. <br />r r___L <br />| SMpendWtitr <br />HmExinpjtUW 1 <br />tree weeks prior to <br />Date <br />1" <br />GK!>^0 <br />Cm <br />I am providing the following coid temperature control for the caM holding of potentially hazardous foods below <br />45T (if food Is used the foltawing day, maintain below 41 *F temperature): <br />□Hee chests Refrigerator <br /> Refrigerated truck Ice bath and tube <br /> Other (8pe«fy)_____,_w ——« <br />® Three deep tubs (basins 6^ inches minimum), one for soapy water, one for rinsing and on® for a bteeoh <br />Elution (one MMespoon of bleach per gallon of water). <br />S Detergenl, bleach, and wiping cloths (cleaning towels). <br />M 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 />AH 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 />thU event xS . z <br />____ <br />THfo <br />1888 E. Hazelton Avenue} Stockton, California 952051 T 209 468-34201 F 209 464-0138 | www.sjcehd.com <br />EHD1W32 PiaeeofM <br />QTWiT <br />j Pre»wwT«rtc ,