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Environmental riealth Department <br />11. <br />OR <br />12. <br />13. <br />"Important** <br />Health Permit <br />Papsr Towela <br />Cuttina 8aare <br />StCTUB <br />Prodans Tank <br />Ice Cooler <br />Ps^e a of 11 <br />Sl^rTKi «/C huffing <br />□lati <br />Garbage <br />Can <br />Booth must be on <br />Concrete, Asphalt. <br />Plywood, or a Tarp <br />5-20 <br />H«nd ■*MH water <br />EjrrfcW <br />fil^ach i'Afclarfor <br />itorng'i’png de*1S <br />Title <br />10. I <br />V^I <br />SANJDAQUIN <br />-----COUNTY------ <br />GreotBwx 9rows h<»re,. <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) _____________—--------------------------------------------------- <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />vfa Three deep tubs (basins 6^8 inches minimum), one for soapy water, one for rinsing and one for a bleach <br />r \ solution (one tablespoon of bleach per gaHon 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 tor adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Water supply dispenser with warm water at a minimum of 100T (i.e. 5-20 gallon container with spigot). <br />'g] One separate tub (bucket or basin) for the collection of rinse/waslewater. <br />Paper towels and pump-styte soap container. <br />Names of responsible persons to be present in booth during all hours of operation. <br /> //i/a A ---------------------——----------------—-------- - <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 of <br />preparation and operation. Return original tQ_festival gggrdinator three weeks pr------- <br /> <br /> <br />14. Completed by: <br />W I EkfrsfwftjyrX^TXMJCcinuiji... .... 81 ba <br />w ilome t frickfJ elfoiVA gicixv'1 <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | Vlf*w's^WpEVEhn.App <br />EHD 1002 P^aolli <br />07/3/1? <br />BJuacri <br />RlniwWitarSo«p arid Water <br />Fire ExItoMJWlAf