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Environmental Health Department <br />11. <br />OR <br />12. <br />13. <br />“Important** <br />14. Completed by:Z <br />Health Permit <br />Piptf H*nS Toz»l> <br />Soaa duKruci <br />irJf a <br />EPasdiPrep*n« Sion <br />U <br />Prvreni TaM <br />I Rm« Witef Pioich »ns Water <br />Page 8ol 11 <br />5 <br />EHD 16-02 <br />06/1S/I9 <br />S. rmo „Cn»»r'3 <br />CM* <br />Eifra <br />Wai«r <br />Garbage <br />Can <br />' Booth must bo on <br />Concrete, Asphalt <br />Plywood, ora Tarp <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 />JjSJhree compartment sink. <br />SC*I HMwwh <br />Wails ^I'crCtcr^ei <br />SAN JOAQUIN <br />COUN I V <br />\! / G ‘-Pi’ <br />Title <br />v;' i‘r • < <br />10. 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 4TF temperature): <br />□ Ice chests WRcIrigeralcr <br />□ Refrigerated truck Q Ice bath and tubs <br />□ Other (specify)------------------------------------------------------------------------------------------------------------------- <br />Eitra lea Btgi i fotxl CcnUhtn mull ba <br />ilond 6 hchti olf ol gnund! <br />All 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 al all hours of <br />preparation ant/Operation /Return original to festival coordinator three weeks prior to <br />//U— <br />c i Signature S t Title j.r. - Date / <br />$-20 G«1 <br />y- Hwd waih Water <br />□ Three 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 />□ Detergent, bleach, and wiping cloths (cleaning towels). <br />I-] Tub to store wiping cloths In bleach solution. <br />^QWater 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 rinse/wastewaler. <br />I Fire <br />Ice Cooler j j <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 I wwv2.sigov.org/ehd <br />£H£J !5 02 Page 8 of 11 TEMP EVENT APP <br />/ Zwmi bucMI- <br />/ Ueash & »alei fci <br />/ J ttorfoj w'p-vj ctoths <br />So»p a/x) Water <br />p^Paper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation: <br />______/T/fr i/' ed'C c <br />Cutira B-i' J