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Scan_20230328_2.jpg32 AM <br />Environmental Health Department <br />iroviding the following items within my booth for the sanitary cleaning of food preparation utensil <br />12. <br />Names of r13. <br />"Imports nf* <br />Completed by: 14.Title DateSignature <br />1 Health Permit <br />Pep or Hand Towofa <br />SM3Ch <br />BUudi anrt Wulor <br />TEMP EVENT APP <br />1/1lie mm/maii/H/n/tfinhnr/FMfrn7fi»RnVlivmNBxVdT7llnfpwlflhfi7omlnfilor"1AninHsnnnPnrtlr1=n? <br />CamScannerCS <br />f«l>> ka 0i«* < rvuU >mni la <br />Wont t imHim iWUKxi gnjunat <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 />B’Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />Zfone separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Q^PaP61' towels and pump-style soap container. <br />Slamo uCCMIM) <br />O-w, <br />SOW Hand wuh <br />WuHvwalw CooUdnw <br />5-20 Gai. <br />Hand wmi Vtaw <br />Garbage <br />Can <br /> Booth must be on <br />Concrete. Asphalt. Plywood, or a Tarp. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />tonsible persons to be present in booth during all hours of operation: <br />___________________ <br />blcach 4 witor lor <br />•lortna Wlplns aom» <br />SAN JOAQUIN <br />-—COUNTV -- <br />J Ice Cooler I • <br />11. I anjjxoviding the following i <br />.Q'Three compartment sink. <br />OR <br />Sy I I <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 all hours of <br />preparation and operation. Return original to festival coordinator three weeks prior to <br />this event. <br />i <br />CcodandWanar <br />J___, <br />RlnMWaior I <br />R <br />10. I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />45rF (If food Is used the following day. maintain below 41’F temperature): <br />Qlce chests xET^efrigerator <br />pfffefriqerated truck Ice bath and tubs <br /> Other (specify) _______________________________________________________________ <br />IWjC. Ha/ollon Avenue | Stockton. California 05205 | T 209 460-3420 | F 209 464-0130 | www.sjgov.org/ehd <br />EMOIt-W KW.Boril TEMP EVENT Ar