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Environmental Health Department <br />10 <br />11 <br />OR <br />12 <br />13 <br /> <br />Completed by 14 <br />Date <br />Health Permit <br />r'K*- ►'X'J <br />C. rq b. «r>r <br />Ice Cooler <br />CW« <br />««a3>» «•*»■ »• <br />Garbage <br />Can <br />Poon rw»> t« on <br />Cancrow. Asphalt <br />P Svcod a a 1 aq? <br />i re <m <br />“a-." •«' *** <br />SAN JOAQUIN <br />------COUNTY------- <br />1 <br />< 'OttAU < <br />Title <br />I am providing the following cold lempeuituro control for the cold holding of potentially hazardous foods twiow <br />45 F (if food ts used the following day mamiain below 4IT temperature) <br /> Ice chests jZl Refhgor ator <br /> Refrigerated tarck Ice bath and tubs <br /> Other (specify!—----- --------------- ------- --— ----------------------- <br />one for rinsing and one for a bleach <br />BMC <br />pfj" Waler supply dispenser with warm water at a minimum ol 100 F (i e 5-20 gallon container with spigot I <br />One separate tub (bucket or basin) for the collection of nnse/waslewafer <br />Paper towels and pump-style soap container <br />Names of responsible persons to be present in booth during all hours ot operation <br />•’Important”All food vendor booths are subject to inspect on Please make a copy of Ulis appkeat on in <br />preparation for this event <br />preparation and operation <br />Signature <br />f. - ■ «•» 4 <— X <br />vlvM « MNn & «• sr» x«<’ <br />1868 E Hazelton Avenue | Stockton. CaWomla 95205 | T 209 468-3420) F 209 464-0136 | www <br />ehd iB-rw r^ioi’' <br />o&Mrz&n <br />A copy of this checkl.st must be in the booth at all hours of <br />Return original to festival coordinator three weeks poor fo <br />* 7/V^{ <br />lam providing (he following Items within my booth for the sanitary cleaning of food preparation utensil <br />Gj Three compartment sink <br />r7 Three deep tubs (basins 6-8 inches minimum), one for soapy water <br />A^vtion (one tablespoon of bleach per gallon of waler) <br />j/jOetergent. bleach, and wiping cloths (cleaning towels) <br />'W. 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 />rz’ \ _I v Mf <br />IzL, olzJI <br />I j* *** ** **** [ I * "** I j **** *r*A’**1 I I I <br />jyt----Y <br />I ------- <br />V. t O0MMMT