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Environmental Health Department <br />10. <br />OR <br />12. <br />I <br />43. <br />•♦Important** <br />14. Completed by:Signature <br />■4 <br />Health Permit <br />Propw»8»ort <br />| .ftnpne Tank <br />[B)Men mJ Waite <br />Ice Cooler <br />I, <br />TEMP EVENT AFPPaa«#cf11 <br />I-5 b <br />Slemow/Cunno <br />Obh <br />BOM Hand «m»v <br />WaatswatarCanMnar- <br />! <br />i <br />SAN JOAQUIN <br />COUNTY <br />WnMWBlw | <br />A <br />Booth must be on <br />Concrete, Asphalt. <br />Plywood, or a Tatp. <br />k_____________ <br />GartMfle <br />Can <br />Sari«Mr6«*a<- <br />"I <br />slortny ctoffw <br />I SwpandWWsr <br />Fira ExtingUaMr 1 <br />““St BS WVT&KW: SSW5 5Oration end operation. Return orlpln.l to fretlwl cpCTfliWW Jim W <br />.._ <br />| MOM. <br />T-1 HandwashWMar I <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 />®ce chests O Refrigerator <br />Q Refrigerated truck foe bath and tubs <br /> Other (specify)__ —------------------------------------------------------------- <br />11. 1am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment alnk. <br />GJ Thrw deep tubs (basins W Indies minimum), one for soapy water, one tor rinsing and one for a bleach <br />solution (one tablespoon of bleach per gallon of water). <br />s Detergent, bleach, and wiping cloths (cleaning towels). <br />S 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 />Water supply dispenser with warm water at a minimum of iOOT (Le. 5-20 Ballon container with spiflot). <br />Ona separate tub (bucket or basin) for the collection of rinse/wastewater. <br />^Paper towels and oumthstvle soao container. <br />Names of responsible persons to be present in booth during all hours of operation: <br />1868 E. Hazelton Avenue | Stockton, California 952051 T 209 468-3420 | F 209 464-0138 | www‘s^^]p,l^JJI <br />EHD 1S-02 <br />«7/VT7