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* <br />i <br />Environmental Health Department <br />11 <br />OR <br />12. <br />13. <br />14.Completed by <br />Health Permit <br />Cuing ImM <br />rHuMmSim <br />a <br />honnTm <br />nw wm<BUcnmivuMr <br />FmEMneMw <br />209468-3420 | F 209 464-0138 | www.sjgov.org/ehci <br />“ V » 1 PI LID ri.lDIu T i .rLVP EVENT AP <br />I <br />I <br />f <br />L-u <br />SG« Harden <br />‘AMtiKMiMGonfene- <br />A 7-t Go <br />I Wwah »V»*Sr <br />twicJi ft eraiersy <br />iwriQ wiring aoni <br />| wmmt <br />Names erf responsible-^rr <br />“Important** <br />r1 -7— <br />SHpandW** <br />Ice Cooler, i <br />U^VTurr <br />»to be present in booth during all hours of operation <br /> itecuijQk ivUfCcZg/jo ------ <br />k°0(hs are subject to inspection. Ptease make a copy of this appneatw in <br />operation Return original to festival coordinator three weeks prior to <br />^44/^1 <br />itle /Date ' <br />I 6 TO Ga | <br />- | I L»ld <a«ati »W»tD <br />■7. ■ <br />SANJOAQUIN <br />------COUNTY------- <br />Grrotr,tts yrows Jnrre. <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 fallowing day, maintain below 41 *F temperature): <br />[fe^ce chests □Refrigerator <br />□ Refrigerated truck Q-fce bath and tubs <br />□ Other (specify) <br />preparation for this event A copy of this checklist must be in the booth at aF hours <br />preparation and operatic ~ ' th Invent A y <br />/ I ^Signature <br />MMW-KIxUrv __ _ <br />Tj <br />lam providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />Q Three compartment sink. <br />IZfThnee deep tubs (basins 6-8 inches minimum), one for soapy water, one for nnsmg and one for a bleach <br />sokitwn (one tablespoon of bteach per gallon of water). <br />DOetergent. bleach, and wiping doths (cleaning towels) <br />Q^Tub to store wiping doths in bleach solution <br />&»_«• tap«tarcawBMflMt, I MKriMMiiitarMsniK# ■ <br />E^?*^HaiM*lonAw*n’Jel Stockton, California 952051 <br />oenma Ptgsacrii <br />^arr^providing the following for adequate hand washing fadlitiBs, but separate from utensil wash within my <br />fi'Water suppty dispenser with warm water at a minimum of 100*F (i.e. 5-20 gallon container with spigot). <br />[^Cine separate tub (bucket or basin) for the collection of rmse/wastewater, <br />CP^aper towels and pump-style soap container, <br />8ootn must tw on <br />Cara etc. Asphalt. <br />Plyviood ex a Tarp <br />CL <br />Garbage <br />Car <br />ps^*r»W>3Tow«4 ] <br />< - a■ 3 <br />10.