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"FROM P6FAX NO. <br />Environmental Health Department <br />11. <br />OR <br />12. <br />13. <br />14.Completed by: <br />Sign re <br />Pap^r Hand Towalti <br />Soap dispenser <br />Culling Soard <br />BleachPropanA Stove <br />J <br />Propane T^nk <br />Bleach «nd Waler <br />Fire Extinguisher <br />Ice Cooler <br />Page 8 of 11 <br />Sanlfl2Dr bucket, <br />bleach & water for <br />Storing wiping cloths <br /> Booth must he on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth; <br />Exira <br />Waler <br />5 Gal Hand wash <br />W^ewater Comainer <br />5.20 Gal. <br />Hand wash Water <br />Steo^o w/Chaffhg <br />Dish <br />Cq-OvZA-V^ <br />Title <br />Received Timee<Apr. <br />cnu it>-uz <br />07/3/17 <br />9. n20 1 9S1 1 : 0 1 PN/PNo. 49083S2O5 I T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />Page 8 of 11 TEMP EVENT APP <br />J2 <br />"Important** <br />Z'V".. <br />■I ' .sfc.ar'-';/ <br />.9°’AS <br />10. <br />| Health Permit <br />APR ! 3 2919 <br />HEALTH <br />■ -------------------------------------------------------------------------------- <br />j^Water 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/wastewater. <br />JXj^Paper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation: <br />KgjeVK ^JdVwvSqrt . ___________________________________ <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.—ttt-. z f / <br />Date <br />Garbage <br />Can <br />SANJOAOUIN <br />/ —COUNTY------- <br />grows here. <br />l am providing the following cold temperature control for the cold holding of potenti^jp^azardous foods below <br />45°F (if food is used the following day, maintain below 41 °F temperature): <br />Ice chests O Refrigerator <br />[^Refrigerated truck Q Ice bath and tubs <br /> Other (specify) ________ _____ _________ ______ — <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />O Three cdirtpaftnieht sink. <br />'0 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 />0 Detergent, bleach, and wiping cloths (cleaning towels). <br /> Tub to store wiping cloths in bleach solution. <br />Erihs kx Bags & Fo£id Canfain^r^ be H <br />stored fl fbchos off of iho ground! ■ <br />_ <br />I Soap and Waler Rinse Waler <br />il. 24 2013 10:00PM