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Environmental Health Department <br />11. <br />OR <br />12. <br />E Paper towels and □uma-styte soap container. <br />13, <br />Completed by: 14. <br />Health Permit « <br />F3;#r 1 >j«1 T imkx <br />PiixAe S'-iiwO <br />Tar*c <br />SiMdi arc <br />- <br />YENP EVEhTT APP <br />SsKvlhE <br />S«nr?J»r txrfcrt- bbxti 4 vrar»’*T <br />Cz3tfr5 <br />E^Water supply dispenser with warm water at a minimum of 100T (i.e. 5-20 gaiton container wth spigot) <br />CJOne separate tub (bucket or basin) fix the cobecticn of rinseAwastewiiter. <br />5 Gd Hard vb-ar* <br />V»'«rzhb<rcr Corona <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth' <br />Siemo <br />2^' <br />Ice Cooler <br />SAN JOAQUIN <br />COUNTY — <br />Grrc:n?5j nrow: ncr,. <br />I am providing the foBcwing cold temperature confrtf for the cold holding of potentiaHy hazardous foods befow <br />45*F (if food is used the fotbwing day, maintain below 4VF temperature) <br />0 Ice chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify)________ _____________________________________ <br />"Important”All food vendor booths are subject to inspection. Ptease make a copy of this application in <br />preparation fix this event A coay of this checklist must be m the booth at all hours of <br />preparafron^snd operation. Return original to festival coordinator three weeks prior fp <br />this event/?< io . f <br />Tltte <br />’863E Hazelton Avenue | Stockton, California 95205 | T 209 408-3420 | F 200 464-0138 | w.v’w.sjgov.org'end _ — . m xrkrr 11EHD1S-W Pagc8ct« T--------------- <br />Dtna'ie <br />Date <br />!-l'j Cci <br />-w-'j Vias, <br />! Signature <br />I am providing the fol lowing items within my booth for the sanitary cleaning of food preparatian utensil <br />jv^Three compartment sink. <br />Three deep tubs (basins 6-8 inches nanimum), one for soapy water, one for rinsing and one for a bleach <br />sotetion (one tablespoon of bleach per gallon of water). <br />^Oetergent bteach, and wiping doths (cleaning towels) <br />O Tub to store wiping tfoths in bleach solution. <br />£>tid .t*i Fox ConiafiM •-nwf ** I <br />JdtMKfC I’xthMa H <br />Names of responsible oersons to be present in booth during all hours of operation: <br />I.T' L <br />7~Z <br />3o?p pnd V.’liw flr»H VA»» <br />/ ''i <br />~~Booth must be an <br />"/[ Concrete, Asphalt <br />—Jhy Ptywcod. or ? Tarp <br />■' \_______________J <br /> <br />Gartwan <br />Car. <br />I fon< <br />Z'awt