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II <br />1T P <br />Environmental Health Department <br />11 <br />OR <br />12. <br />13. <br />Completed by 14. <br />Heafth Permit <br />rPrapmeStoMi <br />PrawntTw* <br />ObMcT and 'A»*f <br />m fijeaxhUMr <br />Ice Cooler i j <br />T 209 468-3420 | F 209 464-013S | www.sjgov.org'ehd <br />Bt/tl f t UP rurkT l:rtWP £VENTAM- <br />[felce chests <br />□ Refrigerated truck <br />□ Other (specify) <br />ttfettewalir GOrMbtiC' <br />EwVfi <br />Atrter <br />Sunnza* b.ck*! <br />IScKTi 4 <br />rorf’Q wa^ng de,pt <br />•^1 <br />I <br />SwanoWM* <br />$4 tr <br />I E»ny» few t.TpotfCartaosj.rj .njcroe M <br />’ho Ha4«tt°n Avenue | Stockton, California 952051 <br />W.SrtB P*CeflC/t1 <br />.... 'J ! / I ;; —--/• • ■'^7 V 7 <br />Garbage <br />Can <br />••p****?775’ <br />~z7v^ <br />/Title jDa/e ’ <br />I A .-O Ga | <br />y | I'tnC-ja*.I ' <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash wrth;n mv <br />booth <br />£?VVater supply dispenser with warm water at a minimum of 100'F (i.e. 5-20 gallon container with spigot). <br />[^6ne separate tub (bucket or basrn) for the collection of rinseAvastewater. <br />Lpl^aper towels and pump-style soap container. <br />SANJOAOUIN <br />------COUNTY------ <br />'tr.-cft'4' Grrot.-ms y-o.v: Jirr-r. <br />I am providing the following cold temperature control for the coW holding of potentially hazardous foods below <br />45T (if food is used the following day, maintain below 4i°F temperature): <br />□ Refrigerator <br />tHfce bath and tubs <br />I am prov'ding the following items within my booth for the sanitary cleaning of food preparation utensil <br />1 I Three compartment sink. <br />t?fThnee deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for a bleach <br />solution (one tablespoon of bleach per gallon of water). <br />DUetergent. bleach, and wiping cloths (cleaning towels) <br />L/Tub to store wiping cloths in bleach solution <br />RnM^VMf <br />$HWnB nfQMflrq <br />Du* <br />Booth must be cn <br />Concrete. Asphall. <br />Plywood. <z a Tnm <br />Names of responsible pereqns,to be present in booth during all hours of operation <br />~KM CCUiMpk MAfCCEL-iA/O — <br />••Important" All food vendor booths are subject to inspectton. Please make a copy of this application m <br />preparation for this event A copy of this checklist must be in the booth at all hours or <br />preparation arm operation Return original to festival coordinator three weeks prior to <br />this/rvenl [j / 9 <br />'Signature/^ <br />•• <br />’ •*{ r-c^ <br />10.