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hit pvJ/mii i I ■ >gle.c‘>nV,n a •'''11/1i«njH.nuy_cvei>l jipplkation_21(>9<)3 J3II IN K_.jpg <br />SAN JOAQUIN Environmental Health Department <br />10 <br />11 <br />OR <br />for soapy water, one for rinsing and one for a bleach <br />12. <br />Pi Water supply dispenser with warm water at a minimum of 100'F (i.e. 5-20 gallon container with spigot). <br /> One separate tub (bucket or basin) for the collection of rinse/wastevraler. <br /> Paper towels and pump-style soap container. <br />13. <br />Completed by.14. <br />Health Permit <br />Pape* rundl I wstf > <br />C Jttrg Berne <br />BicachSlv.e <br />a a <br />ftusc Was-. <br />Ice Cooler mi <br />Si <br /> <br />0 <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />[~1 Three compartment sink <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 /> Refngerated truck Ice bath and tubs <br /> Other (specify)__ <br />Sletno ftrOaffrg <br />Onn <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth <br />s-20 Ga <br />ttand Vrfaic- <br />SdrkUd <br />Mcacft & 'JmAui <br />forvz Mpre ckms <br />Booth must be on <br />Concrete. AsphdL <br />Plywood, or a Tarp. <br />BBS <br />"¥1 <br /> Three deep tubs (basins 6-8 inches minimum), one <br />solution (one tablespoon of bleach per gallon of water). <br />O Detergent, bleach, and wiping cloths (cleaning towels). <br />0 Tub to store wiping cloths in bleach solution. <br />Soapard rtafcr <br />Signature <br />z-x | FireEtcngusrei <br />Garbage <br />Can <br />S&J iA <br /> <br />I Pioparv lark <br />Names of responsible persons to be present in booth during all hours of operation:LUSuKz fa-dUn _____________________ <br />"Important** <br />Usa fccOoffs 4 fcoa tx <br />gKhcs Q* ci tnc puurX <br /> __ <br />93/2021.6* <br />SGaiH^rtwasr- <br />_ <br />1853 E Hazelton Avenue Stockton Cal fornia 95205 I T 209 458-3420 F 209 464-0138 <br />EHD 1602 Page 6 of 11 <br />0&1&’19 <br />" ..”<7 ■ ‘ <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. 1 i . /) „------LauL 7/7-U o«>nz£zL <br />Tide Date <br />W .-r.V S-qev a'QfEM <br />TEMPER APP