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about:blank <br />Environmental Health Department <br />10 <br />11 <br />OH <br />12 <br />fC! Watt* suppiy dispense? with warm water at a minimum of 100‘F (i.e 5-20 gaUon container wth sp^ct) <br />13is <br />•‘Important” <br />Completed by14.6at«nature <br />$*«*•>> <br />hew T weft <br />F*4€.*m Tart <br />G«p»g« <br />Ice Cooler <br />10/20/2022, 7:42 PM1 of 1 <br />f^lOne separate tup (bucket or basin) for the col'-ection of r ns wastewater <br />P.sper towels and pump-Shfe soap container <br />O Ib-r** tuns (Nrs ns ♦> H ,r»<hes mtnimum) one lev soapy wuter <br />sotption tone titMesooon <V bieach per tpicn of water) <br />L J Detergent WerK-h a'xt w pi-xj cloths (ciearung towels) <br />f I Ti,b to store wptr'Q cloths n biriKh sokition <br />tijor tXO et'd <br />ttur »n«’ iv <br />s-it ca <br />Hactf Mfiwx <br />fc«V <br />Itn-SAQ MIWMI 1-H*« <br />Boom must t» cr <br />Concrete Mpna* <br />PtywocxJ or » Tan <br />t <br />I) <br />1II <br />I .n'T'> frtH Kithe f'Wk^A’K'Q 'ffuk fT'y bixth fry !b>e ^Antbvy rjr^n.n^ of •^<»d ut*ns«i <br />■S3 Throe compartment snx <br />imagejpeg_O.JPG <br />I am pmvidng the following f<x adequate hand washing facilities, but separate from utensl wash wShn my <br />booth <br />5'acs‘on C«lPorna 95205 I T 209 468-3420 1 F 209 464-0138 I <br />Ps^torttifinflE Haze ton A .e' .e | <br />IK) <br />ore for mw^ and or« kx a b«eacti <br />Health Permit R <br />I si'T- frov «1 nq the v u >a rxj com trm; r-.iturn cn<vini *<x *'** cold hr. i rwj o( pc’erta iy hazardous ’<XX5S <br />45 f (r tooc ‘5 mrd trw' \ «■»*• •”'o <1 »y ntain ONca 4’ > temortaturej <br />hQ ke ChCStS J Ur'fftejrt At(< <br />I J Vrcl •nr fc H r h,Vh v d H»t>« <br />[ 1 Othc* 1 _________________ ___ <br />SAN JOAQUIN <br />Karies of responsible persons present m booth dunng all hours of operation: <br />C< ta^sbuQ'-c __________________ <br />An food vendor booths are sucyect to inspection. Please make a copy of th® appucatxxi m <br />preparation for this event. A copy of th® checklist must be tn the booth at ait hours of <br />preparation and operation. Return original to fesbval_cpoL4|n^pT.thfyejwe^ki prior jo <br />. / j_________fy^c/ <br />Title Sate