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Environmental Health Department <br />10 <br />11 <br />OF? <br />12 <br /> Water supply dispenser with warm water at a minimum of 100"F (l.o. 5-20 gallon container with spigot) <br /> One separate tub (bucket or basin) for ths collection of rtnse/waslewaler <br />[\] Paper towels and pump-style soap container <br />Names ot responsible persons to be presort In booth during all hours of operation:13 <br />Important** <br />Completed by: 14. <br />Signature <br />Health Permit <br />~1 <br />£ <br />PtOMfu Tar A <br />•nJ Vo*’***Rmv WnlMtSewn *odV*ah* <br />rit< EihnoiMrw <br />Ice Cooler <br />I am providing the following cold temperature control lor lhe cold holding of potentially hazardous foods below <br />45’F (if food is used lhe following day, maintain below 41 "F temperature). <br />T^lce chests Refrigerator <br /> Refrigerated truck O Ice bath and tubs <br /> Other (specify) _ <br />I am providing the following iisms within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />Sf»mc> wCh«mnQ <br />Oba <br />SOdlU.xl ww»h <br />' Cental <br />Sirtiuw tuaufU <br />mmcJi A raw for <br />■ttwvtfj tnonq UoOm <br /> Three deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for a bleach <br />solution (on© tablespoon of bleach per gallon of water) <br /> Detergent, bleach, and wiping cloths (cleaning towels) <br />[31 Tub to store wiping cloths In bleach solution <br />S-M UJ <br />HiiM wauli Maim <br />Gasbag o <br />Cttn <br />I am providing lhe following for adequate hand washing facilities, but separate front utensil wash within my <br />booth <br />SfiN JOAQUIN <br />COUNTY — <br />/ <br />I tiCMUf rttiw <br />All food vendor booths are subject to inspection. Pluase make a copy of this application in <br />preparation fpr 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 />/^o ^1'? 7 <br />Title Date J <br />--------------------- <br />Booth rnvivt be on <br />Concroto. Asphnlt <br />Plyvwwxi, cm A Tarp . <br /> _______________/ <br />i xfr» tee fk»7-. C hwn Ccvrtarwi nw«f be |< <br />itMhi B Jnchec bl/o/tfi* avutmiM <br />1868 E. Hazelton Avenue | Stockton California 95205 | T 209 4 68-3420 1 F 209 464-0138 | www.sjgov org.'ehd <br />1:110 16-02 P»|jc8oH1 ItMPfcVbMI AI»P <br />W2O«3 <br />Cana <br />Water