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P3i.FAX NO. <br /> <br />Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />13. <br />"Important** <br />14.Completed by: <br />Si,isture <br />Health Permit <br />PW«r KM TomM <br />Soop(^Mn«4r <br />Oeedt <br />SMArdWur <br />Ice Cooler <br />PegaBofi-t <br />1:43PM No. 4972Received Time Apr. 28. 2019 <br />j <br />I <br />EMO 16^2 <br />O7/3H7 <br />Crfr» icv tegc 4 Fmi b* <br />Stonn wri2h(rfEng <br />Dttfi <br />burttX- <br />btoadi A MH*r far <br />Mfidlig «NpMg cMh« <br />5(W MftMWMh <br />Booth must be on <br />Concrete. Asphalt. <br />Plywood, or a Tarp. <br />i <br />J <br />«-» OM <br />HMwmWMW <br />SANrJOAQUIN <br />-------COUNTY------ <br />Crfotnen grcwt here. <br />‘ ,the f°'tow'n9 COM temperature control for the cold hoWinfl of potentially hazardous foods below <br />45 F (if food is used the following day, maintain below 41 *F temperature); <br /> Ice chests Refrigerator <br /> Refrigerated truck (ce bath end tubs <br />pother (specify) TieCZ^O- <br />Garbage <br />Can <br />™ m ’ bteach <br /> Detergent, bleach, and wiping cloths (cleaning towels). <br />LI Tub to store wiping cloths in bfeach solution. <br />ttefnS Wrthin booth the cleaning of food preparation utensil <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 46S-3420) F 209 464-0138 | www.sjcehd.com <br />a_«.« TEMP EVENTAPP <br />I Cuungd°*M I ____ <br />PnK>«n»S*ow I <br />,^r7l~T~T~T^~f: <br />Propane Tw* j i ~ .>T --------- <br />Z I I--■ "•“-"I <br />ham^prowding the following for adequate hand washing fedgties, but separate from utensil wash within my <br />^Water supply dispenser with warm water at a minimum of 100*F (Le. 5-20 gaBon container with spigot). <br /> One separate tub (bucket or basin) for the collection of rinsefwastewater. <br />f^LPaper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during aB hours of operation- <br />^aViv> C.\\tA&kn^gr\, Of CJryis.H-^ L^-»AV <br /> Ail food vendor booths are subject to inspection. Ptease make a copy of this application in <br />preparation for this event A copy of this checkSst must be in the booth at all hours of <br />preparation and operafkm. Return original to festival coordinator three weeks prior to <br />thifr.gvent. (fj ------- <br />------ - ruhug- <br />Title Date <br />H’ ' I '- '• <br />jg. 12 2013 12:41PM