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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />tH Water supply dispenser with warm water at a minimum of 100oF (i.e. 5-2.0 gallon container with spigot). <br />(jH'Ono separate tub (bucket or basin) for the collection of rinso/wastowator. <br />I^Paper towels and p.ump-stylp_spap container. <br />13. <br />"‘Important** <br />14.Completed by:. <br />| I loalth Permit (■'I <br />I ’upOT I fluid Towels <br />| I’.onp clisponsor | . <br />I <br />Iliirio Witlor <br />Ice Cooler <br />Q 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 />| 1 Detergent, bleach, and wiping cloths (cleaning towels). <br />I..] Tub to store wiping cloths in bleach solution. <br />Garbago <br />Can <br />Snnltizor buckot- <br />bloadi A wntnr for <br />storlnu wiping dotlis <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />fitoino w/CJImning <br />Dl.ih <br />18681-. Hazelton Avenue | Stockton. California 95205 | T 209 468-3420 | I- 209 464 0138 | www.sjcehd.com <br />I IID1G-02 I’aocOoHI II Ml»f VI Nl Af’l’ <br />0//3/I7 <br />SAN,JOAQUIN <br />COUN I Y <br />(>i .•ul .•h-ss oii'v.1. ht'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 />IZl Refrigerated truck 1.1 Ice bath and tubs <br />□ Other (specify) <br />| fCJ S-n Booth must bo on <br />A ' Concrolo, Asphnll. <br />aJo Jukdr L. °r“ 1“r": <br />■■Gnllkindwiish <br />WnslowntorConl.'ilnor <br />Date <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />FA Three compartment sink. <br />[ llloucti <br />Titlo <br />5-20 Gnl. <br />I land wnsli Walor <br />| I'nip.win l ivik <br />(itnacb mid Watnr I <br />Names of responsible persons to be prp^ent in booth during all hours of operation: <br />1_ ___________^721/^-77 __—t f <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 throe weeks prior to <br />this evenly <br /> <br />✓Signati <br />r 1 Wi*;I <br />I xti.i Ice lings A Food Conlnlnots nuisl be ; <br />utomd t> Inches efl o! tho ground! <br />Cvlliriil lioaid | • <br />PropnnoSlovn | . <br />| lionp mid Wiilor | [ <br />I Iru I xUngulslKir