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SAN JOAQUIN Environmental Health Department <br />to <br />11 <br />OR <br />12 <br />13 <br />••Important** <br />Completed by14 <br />Health Permit | <br />S.’4X> d'’/w n*’ <br />B- ■*> rl <br />a <br />wiCf'.W* •«( <br />0'5' <br />Three deep tubs (basins 6-8 inches minimum), one for soapy water one lor rinsing and one for a bleach <br />Ration tone 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 />Buolh musl be or <br />Concrete Asphan <br />Plywooc o' a 1 an» <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />J Three compartment sink <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />45°F uf food is used the following day. maintain below 41 F temperature) <br />ffijce chests Refrigerator <br />E~ Refrigerated truck Q Ice bath and tubs <br />□ Other (specify) <br />arbacj* <br />Can <br /><'• T ?') <br />f i';< R of • ' <br />Ice Cooler <br />Water supply dispenser with warm water at a minimum of 100 F (i.e 5-20 gallon container with spigot) <br />^^One separate tub (bucket or basin) for the collection of nnse/wastewater <br />^^Paper towels and pump-style soap container <br />"BbSt Hazelton Avenue | Stoc kton. C.i ’ it <br />f HO 1602 <br />; I vn <br />S^rxlirr <br />H 'u« <br />i j ■<) * i»"fl <br />Qt’V U’C *?hd <br />Kwr F .f ut APP <br />Names of responsible persons to be present m booth during all hours of operation <br />23^_______________ <br />All food vendor booths are subject to inspection Please make a copy of this application -n <br />preparation for this event A copy of this checklist must be in the booth al ail hours of <br />preparation and operation Return original to festival coordinator three weeks prior to <br />this event. . I I <br />Signature Title Date <br />5 r. n! uM> 7- . • •