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FROM 8 2013 8:03PM P3FAX NO. <br /> <br />19- <br />Environmental Health Department3 <br />10. <br />11. <br />OR <br />12. <br />container. <br />I13. <br />14.Completed by: <br />Signature <br />Health Permit <br />Q <br />temp event app <br />Received Time Apr, 24. 2019 9:06PM No. 4957 <br />ai«mo <br />W <br />SCMManawift <br />WMttMMr CtMatar <br />d-ao GM <br />HmdwmhWMar <br /> Booth must be on <br />Concrete, Asphalt <br />Plywood, or a Tarp. <br />EM* fas BU(P JL F9Od Gatoifim M <br />tSOf9d 6 O^UTO^ ^Oorxf <br />I I <br />Garbage <br />Can <br />SAfifeMr bucfcrt. DiMKh & wate r tor <br />MOHngwifNtiQ cfcttns <br />• 6..- <br />i <br />1 <br />‘ T <br />L-’,’• _ <br />Um^provWing the fofiowfng for adequate hand washing fadlties, but separate from utensil wash within my <br />’QjlTree'oom|»rtn»nt^rrf«lt0mS Wilhin boo*h for sanitary cleaning of food preparation utensil <br />Ice Cooler <br />preparation for this event A copy of this checklist must be in the booth at afl hours <br />.A. A .* *--------AT _ A *■ w _ a. . __ <br />thr^jvenL <br />SANJOAOUIN <br />------COUNTY------- <br />Gieatnc^i her*. <br />1 45-FSS ,or potentiany hazardous foods below <br />45 F (if food is used the foikjwmg day, maintain below 41 *F temperature): <br /> Ice chests Refrigerator <br /> Refrigerated truck ice bath and tubs <br />^Other (specify) TveC'Zeo-_____________________________________ <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-34201 F 209 464-0138 I www.dcehd com <br />PnswBorn TEMP EVEN! <br />P>Bt»o»T«r* -------------- <br />(basi?? inches rnin'mufT’)< o'1® for «»py water, one for rinsing and one for a bleach <br />solution (one tablespoon of bleach per gallon of water). <br />LJ Detergent, bleach, and wiping cloths (cleaning towels). <br />u Tub to store wiping doths tn bteach solution. <br />^AVater supply dispenser with warm water at a minimum of 100*F (i.e. 5-20 gaSon container with spigot). <br />Q One separate tub (bucket or basin) for the coflection of rinsefwastewater. <br />^Paper towels and pump-style s <br />Names of n^ponsibfe persons to be present in booth during afl hours of operation: <br /><k)hv\ CYwiskmeiA o< liqas <br /> <br />“Important** AD food vendor booths are subject to inspection. Please make a copy of this appScation In <br />preparation for this event A copy of this checklist must be in the booth at afl hours of <br />Preparation and operation. Return original to fastrv^ coordinator three weeks prior to <br />CWfML^ A l°( <br />Title Date <br />StworMWMr I"| <br />0 <br />I CMBH9Bo<rt <br />Ptotuneww.