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Environmental Health Department <br />10 <br />11. <br />OR <br />12 <br />13. <br />“Important** <br />14.Completed by <br />Signature Title Date <br />Health Permit <br />-iia- ~Mta <br />E-sac <br />IP.-npane :»* <br />Fw» E*ar^»u«?mr <br />5 i'<5et □S'tf the <br />Eca <br />Diescfi I wa»r <br />Etarrg <ijr4 <br />Sl»tTK> ■Chaftn; <br />: v <br />5 Ga Hjnc mv <br />Corux.-a- <br />G») <br />KandwuhWstar <br />Garbage <br />Can <br />3 Water supply dispenser with warm water at a minimum of 100’F (i.e. 5-20 gallon comaker wrh spigot) <br />O One separate tub (bucket or basin) for the collection of nnse/wastewater <br />n Paper towels and pump-style soap container <br />SAN JOAQUIN <br />-----COUNTV <br />Names of responsible persons to be present tn booth during all nours of operation <br />Steven Pom hack Artie Gcnzalsz <br />Bvotti must t» on <br />CcnoBte Aspnal! <br />Plywood or a Tarp <br />________ > <br />Ice Cooler <br />___ F <br />lam providing the following items within my booth for foe sanitary cleaning of food preparation utensil <br />Three compartment sink. <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 />Owner 05-10-2019 <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 />Lj Detergent, bleach, and wiping cloths (cleaning towels} <br /> Tub to store wiping cloths m bleach solution, ” <br />I am providing the following for aoerjuate hand washing facilities but separate from utensil wash within my <br />booth. ' <br />, 7' i <br />I <br />ureupieii f*«rr <br />I am providing the following cold temperature control for the cota holding of potentially hazardous foods below <br />45T 0f food is used the foltowing day. maintain below 41 'F temperature) <br />Q Ice chests 2 Refrigerator <br /> Refrigerated truck ice bath and tubs <br />0 Other (specify) Refrigeration on mobile food facility <br />J 868 E Hazelton Avenue | Stockton California 952051 T 209 466-3420 | F 209 464-0138 I www.sjcehd.com <br />Pagoaafll TEMP EVENT AFP