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<411 li .Kill <br />Environmental Health Department <br />10. <br />12. <br />. . <dter supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />13. <br />All food vendor booths are subject to inspection. Please make a copy of this application in••Important** <br />Completed by.14. <br />Signature <br />Health Permit <br />Hrt I owO <br />I <br />Propane Tank <br />Fn Exunout*'*fl <br />Ice Cooler <br />iniiiniiiu i.}’ Hi/ nnm ffinim i nnLiiininnfHHnnninmnnunnnnijffirnnjnwnimtnnHrninnfhiMHmfHfnnf <br />Sanemr buckal- <br />1 waler tor <br />•torna w^ng dotfn <br />4 Gal llnl wan <br />Waetewaler Cortaner <br />Garbage <br />Can <br />Boom must bo on <br />Concrete. Asphalt. <br />Plywood, or a Tarp. <br />Eika <br />V-.'.r™ <br />_..e^separate tub (bucket or basin) for the collection of rinse/wastewater. <br />^er towels and pump-style soap container. <br />I auKT, <br />Names of responsible persons to be present in booth during all houra of operation: <br />Title <br />E <br />Soap and Water <br />preparation for this event. A copy of this checklist must be in the booth at all hours of <br />preparation and operation. ~ u.--.--4..—~ . <br />this event. <br />Return original to festival coordinator three weeks prior to <br />Date <br />X3 <br />Rlnu W»W <br />5-20 Gal <br />r- Hand warn Wtfar <br />[ Snap aipantar | ----------- \ <br />Citn KtUnjil Food ConltMen ntol bo r <br />Uond » mchor c/t tha ammli .1 <br />1868 E. Hazelton Avenue | Stockton. California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />EH0 1&-02 Pago Bor 11 TEMP EVENTAPP <br />07/3/17 <br />| J UlaxhandWaw <br />11. I amjxdViding the following items within my booth for the sanitary cleaning of food preparation utensil <br />0lhree compartment sink. <br />OR <br />...>ce 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 />O 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 />SAN JOAQUIN <br />bl- -----COUNTY------ <br />I'-'rn-(ju’*'r C./rrrtnm g.e«»s h.it, <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 />tests D Refrigerator <br />B'Ftefrigerated truck Ice bath and tubs <br /> Other (specify)'/QOcJ- J'S-------------------------------------- -