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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />13. <br />14.Completed by:. <br />I'apor Hund Towel.i <br />I ]•CuKiny lloiird <br />I <br />Ice Cooler <br />1 .1 ID 1G-02 <br />0//.VI7 <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />I | Throe compartment sink. <br />Storno w/<;iin(finn <br />!> Gul I land wnsli <br />W.i-.towator Contaliiot <br />Gaibago <br />Gan <br />finnillzor Inickol- <br />bloach & w.itor lor <br />sloilno wiping dnthu <br />Booth nuist bo on <br />Concroto, Asphalt. <br />Plywood, ora Tarp. <br />I jdnl Ice /Ings A / ood Containers must bn <br />stoted 6 Incbos nil ol Ilin firountll <br />5-20 Gal. <br />I l.-inil wash Wnlnr <br />HinnoW.ilor | | lllo.-u l> mid W.ilor | <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 />/__V/2_ , 3ZO(( <br />/y/z Signature Title Date <br />i <br />‘‘Important** <br />jyPlhree 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 />iZl Detergent, bleach, and wiping cloths (cleaning towels). <br />4^1 Tub to store wiping cloths in bleach solution. <br />Water supply dispenser with warm water at a minimum of 100T (i.c. 5-20 gallon container with spigot). <br />y Ono separate tub (bucket or basin) for tiie collection of rinse/wastewater. <br />Lj^Papor towels and pump-style soap container. <br />Names of responsible persons to bo present in booth during all hours of operation: <br />.. _________________________ ___________________________________ <br /> <br />| 1'rop.vw) Tnuk It,It <br />J Propann Stnvn <br />1868 L. Hazelton Avenue | Stockton, California 95205 | ’I' 209 468-3420 | I 209 464 0138 | www.sjcehd.com <br />innic::? i>.i<jon<>f n f(Mi> tvint Ai’i’ <br />| Sioap dispensor | .... <br />I I loalth Permit ]! <br /> I <br />j iio.ip ,ind W.itur | J <br />l ira I 'xllnpulslior <br />SANJOAQUIN <br />COUN I Y <br />(it col .•ii-s ■. (;/<'»■.•. tn-^i <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 />(fFPlce chests RfcRefrigerator <br />LI Refrigerated truck LI Ice bath and tubs <br />L’l Other (specify)_