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Environmental Health Department <br />fj <br />10 <br />11. <br />OR <br />12 <br />Q Paper towels and pump-style soap container <br />13.to De present in booth during all hours of operation: <br /> <br />••Important* * <br />14.Completed by: <br />Curwu LV drS <br />PhaaarM S’nv..6 a*-7i <br />fre C itnc-j w <br />1 <br />Sc*. .Vri A <»l». <br />F-.tr# <br />Vi Me. <br />5 Ge' ‘l.'v' j wnjh <br />Garbage <br />Can <br />MM ng rtg <br /> Booth must be on <br />Concrete. Asphalt <br /> PiyADOd or a Tarp. <br />Ice Cooler s <br />------------------ <br />A-.t jr«« I <br />SAN JOAQUIN <br />C O U N r v <br />P raper tlane Tc*cr. <br />| Health Permit <br /> Water supply dispenser with warm water at a minimum of 100T (i e 5-20 gallon container with spigot} <br />Q One separate tub (Ducket or basin} for the collection of rinse/wastewater <br />S4» GM : <br />K»r»-. A.i.y <br />O’Vt hero. <br />I am providing the following cold temperature control 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 Refrigerator <br /> Refrigerated truck Ice bath and tubs <br />fl Other (specify) <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment 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 />•J Tub to store wiping cloths m bleach solution. <br /> / y . y ■ i i <br />Sifrre I___ <br /> Jn <br />I fM»a fee Dw 11 om r»v.v f K <br />| AREW C1 UK-free cei PK gfeHjA.I' pS <br />1868 E Hazelton Avenue I Stockton. California 95205 | T 209 468-3420 | F 209 464-0138 | www.siqov orq/ehd <br />8 0.11 luaPr^NTAPP <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth 7 <br />Names of responsible persons t< <br />All food vendor booths are subject to inspection Ptease make a copy of this application in <br />preparation for this event. A copy of this checklist must be in the booth at all hours of <br />preparation and operation Return original to festival coordinator three weeks prior to <br />thi$ event- . < <br />______ S YikqinJ^_______7-4 h 1 7^ 1-0 '^S <br />Signature TWe Date