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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />M 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 rinso/wastowater. <br />fx| Paper towels and piimp-stylo soap container. <br />13. <br />“Important** <br />14.Completed by: <br />Signature Title Date <br />I'apor IUukI Towols <br />| Soap dispenser j . <br />| IMondi <br />^7 lllonch (ui<l Wnlnr <br />fl <br />X <br />i ir<> ExflnguWrar <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 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 />f> Gnl I Innd wmli <br />W.-istow;>lnr Cenlnhior <br />5-20 Gul. <br />I I.xkI wnsli Waler <br />Garbage <br />Can <br />Sanitizer buckot- <br />iHoncIi t water (or <br />storing wiring cloths <br />Booth must be on <br />Concrete, Asphalt. <br />I ’lywood, or a Tarp. <br />Sterne wrtJhnfhng <br />Dish <br />Ice Cooler <br />.1 <br />I <br />SAN.JOAOUIN <br />COUN IY <br />(it «,<il ;i<-S !■ ()ion <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 [X| Refrigerator <br />[ J Refrigerated truck |2I Ice bath and tubs <br /> Other (specify)____ <br />| I loalth Permit p <br />| I'rop.ino Innk <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />M Three compartment sink. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />IJ 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 in bleach solution. <br />Cutting Board | I <br /> <br />Soap mid Wntor | | lUtuo Water | | <br />/ Imtra \ <br />Water <br />l ixir.) Icc Ha<)x A rood Containers nmsl be H [ <br />sforrrrf G Inchos alt <>t Iho ground/ I - J I <br />18681;. Hazelton Avenue! Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />oz/a/ rz °? ' ■'!,n" °f " n .mi > i Vi n i ai ’P <br />Names of responsible persons to be present in booth during all hours of operation: <br /> Mu\ IWhH