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I <br />T <br />Environmental Health Department <br />11 <br />OR <br />12. <br />13. <br />14. Completed by <br />Cbluij <br />ki. • • "i <br />r re Ejc'ctuthdi <br />J <br />L» ’ f <br />1 j I <br />I <br />Fry* i-:« Qa^a n r^Qarrawj .•nj.jr tc <br />iiireJ C in^S JffXVVI <br /><» <br />Hazelton Avenue | Stockton, California 952051----- <br />P*geac/t1 <br />Ert-fii <br />A'4fec <br />I o «* <br />SANJOAOUIN <br />------COUNTY------ <br />Grrnt.-rvij .'irr- <br />1 I I <br />.la <br />1 Heal'n Permit <br />f>r(xijr*) T era <br />3ootn must be cn <br />Ceratite AspKill. <br />Plywood czaTnfp. | <br />Pts«r T j <br />1 <br />Garbage <br />Car <br />n?'’ <br />J i ‘ ( i [-r <br />T 209 468-3420| F 209 464-0138 | www.sjgov.org'ehd <br />B'/’1 tEVP EVENT Ar-‘ <br />iwm*. wiQMrfru <br />Cu*> <br />a copy of !.h;s appficalion i.n <br />(Q J <br />0P• •0n Return original to festival coordinator throe weeks prior to <br />■/k&cg&dL_____'2/'A/z.\ <br />Slynature/ >Tltlo /Da/e <br />} <br />. Prooene Sl>^ <br />Ian’ p’-ovding the follow.ng items within my booth for the sanitary cleaning of food preparation utensil <br />U Three compartment sink. <br />t^^Three deep tubs (basins 6-8 inches minimum), one for soapy water one for rinsing arc one far a bleach <br />soiutror ('one tablespoon of b/each per gallon of water). <br />D<Jetcrgen!. bleach, and wiping cloths (cleanmg lowefa) <br />ub to store wiping cloths in bleach soluten <br />Names of responsible pejsi <br />“Important" <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash v/ith:A my <br />J^/atersuppty dispenser with warm water at a minimum of 100’F {i.e. 5-20 gallon container with spigot). <br />[jrSne separate tub (bucket or basin) for the collection of rinseAvastewater. <br />LP^aper towels and pump-style soap container. <br />/Title <br />__ v <br />| So.X.4 ] .___ \ <br />__ PV <br />3bui)LxJ <br /> I <br />Io be present in booth during all hours of operation <br />1MAfeWie—-------- <br />All food vendor booths are subject to inspection. Please make r ~ ~~ <br />prepar^ion for this even! A copy of this checklist must be in the booth at af) hours <br />preparation an' ~ ‘ . <br />this/fevent. <br />y v <• <» o <» o o «* <I / / /. /_ ////// Zkn <br />>Oin2ik' O-Cfcrl <br />bie*eft & *-j|cr <br />5 —— --- <br />Ice Cooler fi CW» H |rC aaVl !---- <br />A'aitswaut CCtMtihe' I <br />•? -<-• 'J. <br /><f s ’ i • n -1 <br />. -‘TXT-*' <br />10. I am providing the following cold temperature control for the coM holding of potentially hazardous foods below <br />45'F (if food is used the following day, maintain below 4rp temperature): <br />[&1se chests 0 Refrigerator <br /> Refrigerated truck £>fte bathand tubs <br />Fl Other (specify) ______________ <br />S:«o ar>3 p rvw