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Environmental Health Department <br />10. <br />ti. <br />OR <br />12. <br />13. <br />Completed by: 14. <br />IHealth Permit <br />Soav Jisoeo'ser <br />Pr&oana Stove <br />u <br />PtOCfSn® Tank <br />f-Uu fcaihiyuohef <br />1 t.MP l-'.'b'N i Af->’ <br />tzitni /L'» 8a>JJ 4 foc-j Co!lt^r>«r3 Tul.lt>0 <br />Sterne w/Chatfmu <br />Dish <br />5 Gt! Han<1 '*«sn <br />ConiaJr’iH <br />iW <br />SAN JOAQUIN <br />-----COUNTY- <br />t am providing the tollowing for adequate <br />booth: <br />□ Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />□ One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />sanitary clearnnq of food preparation utensil <br />Wlr'j.i ,.Va»' <br />I '.Vslur I <br />_L <br />Sr.GCkton. California 95205 | T 209 468-3420 | F 209 464-0138 ! wwv’ :3l0.oy::'^''?!‘9, <br />PuijO 8 ot ’• 1 •— - - <br />1868 E. Hazelton Avenpt- <br />EHD IB-02 <br />nfi/:»ir?nZ4 <br />>2C Gat <br />Hand wash Water <br />•'important*’ <br />jyj Paper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation: <br />\' /> r.K rA.p I V'ica\)C< Vi! <br />Ice Cooler !■• j <br />I am providing the following items within my booth for the <br />(X! Three coinpailinent sink. <br />□ 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 />□ Detergent, bleach, and wiping cloths (cleaning towels). <br />□ Tub to store wiping cloths in bleach solution. <br />hand washing facilities, but separate from utensil wash within my <br />BUaUi won | <br />NftchA-el <br />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 ail hours of <br />preparation and operation. Return original to festival coordinator three weeks pnoL.to <br /> <br />Stature Title Date <br />B<xAmwi <br />OWp--. : •. ^k-ry^Wl <br />■W&W <br />I am providing the following cold temperature conW for the cold holding of potentially hazardous foods below <br />45°F (if food is used the following day. maintain below 41 F temperature) <br />□ Ice chests W Refrigerator <br />K Refrigerated Huck L; Ice I’nth ;>nd tubs <br /> Q Othef isp' "~ifv' . _______— ----------—-------------------------------------———--------- <br />SVNMCl <br />^Sr^5