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Environmental Health Department <br />10. <br />OR <br />12. <br />13. <br />••Important** <br />14. Completed by: <br />DateTitleSignature <br />Health Permit <br />atmomCMMno <br />Sowdapanwr <br />Propane 6»w <br />MropanaTw* <br />HMcnMWUr <br />JF>i SMinefchar <br />ice Cooler <br />j <br />TEMP EVENT APP <br />_K' <br />M0(M <br />HMMMMMr <br />® Water supply dtapenaer with warm water at a minimum cf 100*F (l.e, 5-20 gaton corteiner with spigot). <br />One separate tub (bucket or basin) for the ooBedion of rinse/wastewater. <br />WNtaNbrCwMw <br />Paper towels and oumo-stvle soap container. <br />Names of responsible persons to be present in booth during aS hours of operation: <br />SvewtackM* <br />btaMtr*wattrfer <br />■Mtaawtpinsclalht <br />I am providing the foltowing cold temperature control for the cold holding of potentially hazardous foods below <br />45*F (if food is used the foflowing day, maintain below 41T temperature): <br />Hlce chests Refrigerator <br /> Refrigerated truck lea bath and tubs <br />O Other (soecifv) ___ <br />AN food vendor booths are subject to inspection. Please make a copy of thte application in <br />preparation for this event A copy of this checklist must bo in the booth at all hours of <br />preparetton and operation. Mum ortdnal to foedval cpordtnstof thrw <br />K <br />ii. <br />SAN JOAQUIN <br />COUNTY <br />2 <br />Garbao* <br />C«n <br />r _L <br />SM»MWMr <br />Booth muM be on <br />Concrete Asphte. Plywood, or a Tarp. <br />fij 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 />Q Detergent. Wench, and wiping cloths (cteanlng towels). <br />Tub to store wiping cloths in bleach solution. <br />I am providing the following for adequate hand washing facikties, but separate from utensil wash within my <br />booth: <br />X 7, <br />| MWHW | <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />O Three compartment sink* <br />1868 E. Hazelton Avenue | Stockton, CaUfomia 952061 T 209 468-34201 F 209464-0138 | www.sjcahd.com <br />END IMO <br />OTrtAT <br />k <br />3U