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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />Q Water supply dispenser with warm waler ala minimum al 100sF (i.e. 5-20 gallon container wrfii spsgol). <br />13. <br />“Important ** <br />Completed tjy: 14. <br />Title <br />Health Permit <br />s» HmivJ f <br />S'**!M SSk>W <br />f n z <br />Sa***/* aru *<<>* <br />Hts L.xSt'^&tvsr <br />siiH <br />I am providing the loitowiny items within my booti for the sanitary cleaning of food preparation utensil <br />□ Three compartment sink. <br />□ One separate tub (bucket or basin) lor the col tec ton of rinse/waste waler. <br />per teweisanJ pump-styte soap container. <br />Names of responsible persons Io be present in booth during all hours of operation: <br />Agneta Almertdares Montano <br />£jrrr* Jk f aatil&atifanHrto mtifDt <br />tntfktftaf uf gint^ra^mf <br />5-20 Cd. <br />Ha»td stse&i Wdjw <br />BoaUh must te <n <br />Carter ese, A^phdt. <br />Pl)U*oad, or a Tarp <br />I am providing the foltawing for adequate hard washing facitibes. but separate from utensil wash within my <br />booth: <br />b Gat htavd <br />WttdMflwtor Caitoh«r <br />5ri»<L£wrbi£&dL- <br />btariJf tar <br />isLulltJ cUL^Sr <br />Gjtiiags <br />Cast <br />11/15-17 <br />Date <br />All food vendor booths are subject to inspection. Ptease make a copy of this appheabon 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 />~ Signature <br />SAN JOAOUIN <br />—-COUNTY’-— <br />Greatness grows here. <br />I am providiirg the following cold temperature control for the cold iiokiing of potenbaffy hazardous bods below <br />45:F (i (ockJ is used the fallowing day, mamtetn below 41:F temperature): <br />chests Q Refrigerator <br />fl Refrigerated truck (~| Ice bath aid tubs <br />Q Ollier (specify) <br />Ice Cooler <br />18€8 E. Hazelton Avenue | Stockton, Cstiifomia 95205 | T 209 4G8-3420 | F 209 464-0138 | www.sjcehd.cwi <br />a-iois-ce P«p8orn lEfePEVEMTAPP <br />07/317 <br />□ Three deep tubs (basins 6-8 inches minimum), one for soapy water, one far nnsmg and one far a bleach <br />sohbion (one tablespoon of bleach per gallon of water). <br />B'Uelergent, bleach, and wiping cloths (cleaning towels). <br />QTub to store wipng ctofhsm bleach solution.