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ealth Permit <br />brawl <br />6-c-.226.• Iry <br />Shona leGn.odirg <br />D,sn <br />5-20 Gat. <br />I land wash Willa, <br />Paper tlInd lrowv,3 <br />bacct- <br />bleach & watar lor <br />%tunny wiping dc1115 <br />I <br />1.3_,.................„.. to& 1ogjja)..,a <br />Garbage <br />Can <br />_ <br />Ice Cooler ,,A, P.14.0410,144AIA0 de, rEF_Ar -2•P IA i <br />I f Alta Ica tlutm II rwal Culda6seee "646I La <br />1110,60 6 646 I oi QM ul Y. ce.unin <br />6 0,11.11•Ad Winn <br />WYWOW44111/ COM1111.11 <br />Soap diVellter <br />Booth must be on <br />Concrete. Asphalt. <br />Plywood, or a Tarp. <br />J2 AM Scan_20230328_2.jpg <br />SAN JOAOUIN Environmental Health Department <br />v <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />45rF (if food is used the following day, maintain below 41°F temperature): <br />Ofce chests ,Erliefrigerator <br />aifefrigerated truck D Ice bath and tubs <br />El Other (specify) <br />I a,•,..eroviding the following items within my booth for the sanitary cleaning of food preparation utensil <br />al Three compartment sink. <br />OR <br />1.._1 Three 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 />7 Detergent, bleach, and wiping cloths (cleaning towels). <br />Tub to store wiping cloths in bleach solution. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth <br />0--Vater supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />T__71.1ne separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Df'aper towels and pump-style soap container. <br />3. Names of responsible persons to be present in booth during all hours of operation: <br />/ .62 <br />"important" 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. <br />14. Completed by: <br />Title <br />A.vonue I Stur:kkoi, califoriiiii 95205 I T 209 468-3420 I F 209 464-0138 I wwvv.slgov.org/ohd <br />i 1644 PAue *1 TEMP EVENT APP <br />ilA enmini211 /1 1/nitfinhnr/FMfrn7t3r1MVIIvmNfixWiTiltranwlfihn7nroloctor=111maRsnrinPnrtld=f1 2 <br />Signature Date <br />1/1 <br />CamScanner