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SAN JOAQUIN Environmental Health Departmon' <br />( <br />11 <br />OR <br />12 <br />13 lames ol responsible <br />4_L£L <br />■’Important’'< <br />Completed t", 14. <br />Signature <br />, Health Permit <br />i <br />/. »e. <br />i3< :!n - <br />I ' 'a I.Ill <br />Ice Cooler <br />1I <br />i, »o _■ <br />i <br />I <br />All food vendor booths arc subject to inspection <br />preparation for this event <br />preparation ano operation <br />this event <br />------ <br />' . Three deep tubs (basins 6-8 inches minimum) one for soapy waler, one for rinsing and oiif for a nl^ac' <br />solution (one tablespoon of bleach per gallon of water) <br />[J Detergent bleach, and wiping cloths (cleaning towels) <br />1 \ Tub to store wiping cloths in bleach solution <br />Title <br />j Soot J -i-otiM <br />Names ol responsible persons to be present in booth during all hours of ofjeration <br />K-CX4- $ ( Pl_______________________ ____ <br />L i One separate tub (bucket or basin) for the collection of nnse/wastewater <br />[V Paper towels and pump-style soap container <br />Hazelt(.»ii Av<-mtie | Strji.klon, California 95205 | T 209 468-3‘l?’ | F JO1* 46-4-0138 <br />(I'll <br />I am providing the following lor adequate hand w.ishmg facilities but separate from utensil wa wiinm <br />bootli <br />t / <br />lyg Water supply dispenser witti warm water at a minimum of 100T (i e 5-20 gallon container w«tr- spigot , <br />Please make a copy of this appli atior > <br />A copy of this checklist must be m the boctl h all hour <br />Return original to festival coordinator three weeks prior to <br /> iz-/'iy u- <br />Date <br />. I ■ - ■ . <br />;«fW*nd <br />I afi providing tne following items within my booth (or the sanitary cleaning of food preparation uu-nsi! <br />% Three compartment sink <br />L <br />: t;. .»! ’ »!<•; <br />w w *. •, ' <br />- Blvdr.n k f-------- <br />.. ■ 1 I <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods t,. i., ■. <br />•yh' I in food is used the following daz maintain below 41 F temperature) <br />/J ice chests iB Refrigerator <br />. Refrigerated truck 3 Ice bath and tubs <br />Q Other (specify)_____________________________