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OR <br />12. <br />13 <br />•"Important** <br />Completed by14. <br />Health Permit <br />Soapdnpenaar <br />CuBngaeattf <br />amen <br />Praoar»S*M <br />it <br />Propwv Tm* <br />J ■McnmdwawrSM*an«W*r <br />FireErtnfluW* <br />, California 952051 T 209 468-34201 <br />Smtarixd* <br />tlnetilw—Iw <br />«mg opng dRN» <br />1868 E. Hazelton Avenue I Stockton <br />£HO 16-02 <br />07/3/17 <br />^MMce cnests <br />□ RRfngerated truck <br />1 1 Other (specify) <br />Water <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth <br />Stem wOiafMg <br />O«h <br />I I Refngerator <br />EJ Ice bath and tubs <br />SQteHamFlM* <br />WMteMter CortMW <br />5-20 GM <br />MwawMn wmbt <br />GartMQ* <br />Can <br />Names of responsible persons to be present in booth during all hours of operation: <br />Booti mutt b* on <br />Concfata. Aspha*. <br />Plywood, or a Tatp <br />Ou5l A A <br />Tide <br />— <br />Ice Cooler <br />RkaaWtev <br />Water supply dispenser with warn water at a minimum of 100’F (i e 5-20 gallon container with spigot <br />ffi'One separate tub (bucket or basin) for the collection of rinse/wastewater <br />^^Paper towels and pump sty e soap container <br />F 209 464-0138 I *WVl' si^^T«w <br />I am providing the following items within my booth for the sanitary cleaning of food preoaraton utensil <br />Fl Three compartment sink <br />£*W let t*p t fa* xm to <br />aared e inOxn Oferat gnumt <br />^pKThree deep tubs (basins 6-8 inches ninimum), one for soapy water, one for rinsing and one for a bteach <br />"solution (one tablespoon of bleach per gallon of watei) <br />l^JDetergent, bleach, ano wiping cloths (cleaning towels) <br />ub to store wiping cloths in bleach solution <br />• .. = « - <br />' 11. <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 ail hours cf <br />preparation and operation. Return original to festival coordinator three week* pnor .to <br />^CL^{ .1 A rX OcOPJLA <br />r ) SignaturP Tide Date