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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />13 <br />"Important* <br />14.Completed by. <br />Title Date <br />Health Permit <br />Hard <br />SstC e«er«x. <br />St!* <br />1 r <br />Shxoara ’ar.» <br />H •’m 'A*£!k- <br />Ice Cooler <br />'_cnxxj-x' <br />L <br />Soap ar*: Wry <br />Sunday kuoet- <br />t-*9Kr & *»Jer4Qr <br />Mswg rtr- <br />Names of responsible persons to be present in bootn during all hours of operation <br />_____AJ Navarro_____________________________ <br />Shemc w> C*^xs <br />ZXk?> <br />fejCba <br />Asts' <br />0 Water suppty dispenser with warm water at a minimum of lOOT (l.e. 5-20 gallon container with spigot). <br />□ One separate tub (bucket or basin) for the collection of nnse/wastewater. <br />□ Paper towels and pump-style soap container. <br />5-22 Get <br />• rams wnh Wat*» <br />SAN JOAQUIN <br />-----COUNTY------ <br />LJd-B ‘ce A S-<M QX— L - fie <br />s&rsct e •ntfsas gnuotf* <br />1868 E. Hazelton Avenue | Stockton California 95205 | T 209 468-3420 1 F 209 464-0138 I www sicehd.com <br />P»ge8ufH TtMP EVEW APR <br />□ Three deep tubs (basins 6-8 inches minimum), cne for soapy water, one for rinsing and one for a bleach <br />solution (one tabJespoon of bleach per gallon of water) <br />□ Detergent, bleach and wiping cloths (cleaning towels). <br />□ Tub to store wiping cloths in bleach solution <br />lam providing the following items within my booth for toe sanitary cleaning of food preparation utensil <br />tZi 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 />1 a,T.?fOr«d,n?the followiri9 0010 temperature control for the cold nolding of potentially hazardous foods below <br />45 F (if food is used the following day maintain below 41T temperature) <br />Q Ice chests 0 Refrigerator <br />□ Refrigerated truck Ice bath and tubs <br />0 Other (specify) Refrigeration on mobile food facility <br />Gwtege <br />CanI <br />b^ti’5r0V^in^ tnS fol!ow,n3 for arf&hua'e hand washing facilities, but separate from utensil wash within my <br />B-wr. must t"6 on <br />Concrete Asphalt <br />Plywood, w a Tarp <br />----------------------->