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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />.(^-fWatcr supply dispenser with warm water at a minimum of 1007- (i.e. 5-20 gallon container with spigot). <br />Ono separate tub (bucket or basin) for the collection of rinse/wastewater. <br />j/f Paper towels and purnp.-style_soap container. <br />13. <br />‘‘Important** <br />14. <br />Date <br />| IJIondi <br />Biondi noil Walor <br />I <br />Ice Cooler <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />6 Gul I IiukI wnsli <br />Wnstownlnr Conlnliior <br />Garbage <br />Can <br />SnnKiznr buckol- <br />Wancli A waUir for <br />storing wiping doUis <br />Booth must bo on <br />Concrolo, Asphalt, <br />Plywood, or a Tarp. <br />6-20 Gul. <br />I land wnsli Wulor <br />Slorno wfdinfflno <br />Dish <br />Binso W.ilor | <br />| I'npur I Iruid Iownls <br />I <br />Signature <br />1868 I :. I lazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcohd.com <br />I .HD1G 02 Pageflofll If MP I VI Nl API’ <br />(17/3/1/ <br />Names of responsiblepersons to bo present in booth during all hours of operation: <br /> yxcxvjm Va^v<e.\<. fiosVvQn____ <br />SAN.JOAOUIN <br />C Ol J N I Y <br />(•I r'Dl ru-S’i qhu’-1. nt/c <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />45T (if food is used the following day, maintain below 41T temperature): <br /> Ice chests Ff Refrigerator <br />[ J Refrigerated truck El Ice bath and tubs <br />Jzl Other (specify) <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />^pfYhree 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 />El Detergent, bleach, and wiping cloths (cleaning towels). <br /> Tub to store wiping cloths in bleach solution. <br />| I’roptino I nnk <br />| I 'rop.ino JKovn <br />| soup disponsoi <br />| I-Ulin la> fl.xjs f. I oo<l Containers must tie <br />s(<»c</ 6 Indios elf olllio grotrndt <br />| I loallh Permit <br />. . r <br />Soap muf Waler I I <br />l ira I xtliipul.'ilior <br />| Cutlimi llonnl <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. A <br /> <br />Title <br />Completed by: