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Environmental Health Department <br />10. <br />4Vc.cz.c/' AW bpj.ir^0 <br />O <br />11. <br />OR <br />12. <br />| J Welter supply dispenser with warm water at a minimum of 100°F (i.c. 5-20 gallon container with spigot). <br />13. <br />Completed by: 14. <br />I Paper I hind I owcls <br />I ’ropnno Stowi <br />I iro I xtliiiiulslw <br />I^Ono separate tub (bucket or basin) for the collection of rinse/wastowater. <br />kA|. Paper towels and pump-style soap, container. <br /> Throe 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 />[ "J Detergent, bleach, and wiping cloths (cleaning towels). <br />I I Tub to store wiping cloths in bleach solution. <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />J/^Three compartment sink. <br />. t?? <br />I xlr.i Ice ll.iy* A f ood Cmilahtcts intisl be ; <br />stoied 6 Inches oil of the omnndl <br />{> (>nl I Innd wnsl) <br />Waslowalor Contnlnor <br />Garbage <br />Gan <br />Sanitizer Inickot- <br />blonch A wator for <br />storing wiping cloths <br />Booth must boon <br />Concrolo, Asphalt. <br />Plywood, ora Tarp. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Stomo w/ChnfHng <br />Dish <br />■ - -...................... <br />Ice Cooler | <br />I ■ Ac ■ 'i.,y | <br />Date <br />| tllunch <br />C.oop (h-pon.'.or | <br />SAN JOAQUIN <br />COUN I Y <br />(il i-llt OHH'.'. hi'C <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />45°l; (if food is used the following day, maintain below 41T temperature): <br />[ J Ice chests (^Refrigerator <br />( J Refrigerated truck z (_.] Ice bath and tubs <br />Other (specify)_________________ _ <br />Names of responsible persons to bo present in booth during all hours of operation: <br />PK; \ crC YtxAt/w' <br /> <br />18(581-. Hazelton Avenue | Stockton. California 95205 | T 209 468-3420 | I- 209 464 0138 | www.sjcohd.com <br />IJID1G-O? I’.-igc 8 of II ((•MP IVI NI Al ’I’ <br />07/3/17 <br />Title <br />5-20 Onl. <br />i- I kind wnsli Wntor <br />: I ■][£/[ <br />IKondi ml Wntor j | | <br />Soap mid Wntor I HmsoW.itor <br />/ I xkrt \ <br />I Wator I <br />I I “ <br />| I'copanoTiink <br />| I loalth Permit <br />*Almportant** 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 bo in the booth at all hours of <br />preparation and operation. Return original to festival coordinator three weeks prior to <br />this event. <br />Signature <br />| Culling Hotird