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- <br />Environmental Health Department <br />OR <br />12. <br />pnL <br />14. Completed by: <br />Health Permit <br />P»0«i 8 ol 11 <br />Ice Cooler <br />WOQM <br />Hand WMv <br />Garbafle <br />Can <br />JrruaiM* <br />aMM «*«•*»■ <br />SUHnadCMSiV o* <br />|/ehd <br />■VENT APP <br />Booth must tM on <br />ConcmW. Aapha*. <br />Plywood, or •Twp. <br />[ CuMnpaovd | <br />PiOpaM*t»a <br />13. <br />___ . <br />_____!— <br />-Important"Xa^for tMs^nL XX of"* <br />anw 4 .» . t A a*. 4.* <m A i * « m ■**4 A n 1r I r ir aatfa ■’uf it w 8 >4 ■□MTHZM KL<iratg^arttnweraborxRrti <br />f Signature <br />| ftcpanalar* <br />■■I <br />tCMHrtndwwx <br />WMtowOw Ownanw’ <br />SAbbJO AOUIN <br />; ------COUNTY— <br />- C},rn’n' " c' n'v' ' ' ' rnnirni for the cold holding of potentially hazardous foods below <br />,o-1 b9i°w 4rF t0m^a,ure): <br /> ice chests 0Refrigerator <br />^'Refrigerated truck Ice bath and tubs <br /> Other (specify)-------------------------------- -------------------------------------------- <br />it. IaoTproviding the following items within my booth for the sanitary leaning of food preparation uten^l <br />0Three compartment sink. <br />□ Three deep tubs (basins 6-8 inches minimum), one for soapy water, one tor rinsing and one for a bleach <br />solution (one 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 />t am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />SLr supply dispenser with warm water at a minimum of 100T (i.e. 5-20 gatlon container with spigot). <br /> One separate tub (bucket or basin) for the collection of rinse/wastewater. <br /> Paper towels and pump-style soap container. <br />Names of responsible persons to be present In booth during all hours of operation: <br />1868 E. Hazelton Avenue I Blockton. California 952051 T 209 ■168-3420 | f 209 464-0138 | www sjgovorg; <br />EHO ’6-02 Pa®* 8 °" ’ <br />07O1O0W <br />subject to inspection. Please make a copy of Ws appiicat^ in <br />:urn original to festival coordinator three weeks prior to <br />______ <br />Title