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5:45PM P38 2013FAX NO.FROM *19. <br />SAN JOAQUIN Environmental Health Department <br />10, <br />ii. <br />OR <br />12. <br />0 Water supply dispenser with warm water at a minimum of 100"F (i.e. 5-20 gallon container with spigot). <br />0 One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />0 Paper towels and pump-style soap container. <br />13. <br />"Important** <br />/) <br />Completed by. 14.owner <br />Signature Title <br />Paper Hand I <br />Scop <br />Sleachftrnvn <br />Propane Yank <br />1 [Soap and V/ster <br />F'i'e EjfiFKJuiShfcf <br />Names of responsible persons to be present in booth during all hours of operation: <br />bernadet babakolan <br />Slerno w/Chstfiint) <br />l>sh <br />Fxtr.1 <br />Water <br />Garbage <br />Can <br />Sambzer buckei. <br />bloeeh & waier Yor <br />storing wiping doth$ <br />Booth must be on <br />Concrete, Asphalt. <br />Plywood, or a Tarp. <br />Hand wash <br />wastewater Contonei <br />S-20 Gal. <br />* Lind wa,sh Water <br />EHO 18-02 <br />07/3/17 <br />Received Time Apr. 24. 20 1 9 6:47PM No. 4955 <br />Ice Cooler <br />Health Permit <br />J I <br />^lo <br />4/24/19 <br />Date <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 at all hours of <br />preparation and operation. Return original to festival coordinator three weeks prior to <br />this event. <br /><0$ BdQS & rood ContnincfS muz! be <br />stored 6 i.'icJres off of f/»e crrot/nd1 <br />1868 E. Hazelton Avenue I Stockion. California 95205 I T 20S 468-3420 I F 209 454-0138 I www.sicehd.com <br />-.UP-:?, 32 Page 5 of 1) TEMP EVENT APP <br />5 <br />Rrnsc! W.ner <br />l am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />l~~l Three compartment sink. <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 />Q Tub to store wiping cloths in bleach solution. <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 /> Ice chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br />[ ~] Other (specify) al1 baked goods will be prepacked ready to sell at room temp. <br />1 am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: