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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />L^/water supply dispenser with warm water at a minimum of 10OT (i.c. 5-20 gallon container with spigot). <br />13. <br />Completed by:14. <br />I. <br />I’ilpix IIiiikI Towols <br />I <br />I'ropntui Stovo <br />Hhi.TO Wutor■/ <br />II MP I VI Nl Al’P <br />S (>nl I land wasli <br />Wastewater Conl.ilnnr <br />Garbage <br />Gan <br />SnniU/or buckol- <br />btench A water for <br />sterino wiping doVia <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Storno w/Ghnffiiifl <br />Dish <br />I loalth Permit ■ <br />( ( xtr.i <br />I Water <br />i ?-r-r ' <br />] <br />I <br />JL J r H < . X <br />| Hlonch <br />JEM <br />Ice Cooler [ j <br />I arp providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />YI Three compartment sink. <br />[yl 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 />KI Detergent, bleach, and wiping cloths (cleaning towels). <br />Ixfliib to store wiping cloths in bleach solution. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />SAN JOAQUIN <br />CO UN I Y ■ <br />(< i •■(;( .•■<••• 'i <jf <iv. •. ‘if- < <■ <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 />Ice chests Refrigerator <br />/(xf Refrigerated truck Ice bath and tubs <br />El Other (specify)_____- <br />______ <br />^Important*’1 <br />| I'ropniw I nnk <br />Q/] One separate tub (bucket or basin) for (lie collection of rinse/wastewater. <br />Paper towels and pump-stylo soap container. <br />Names of responsible persons to be present in booth during all hours of operation: <br /> vi. \V I I__I _______ _____ <br />kAZL-l—4J-UAXJ1_1.-.eZ---------------------------------------------------------------------------—--------------— <br />) All food vendor booths are subject to inspection. Ploase 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 event.. I, ' Ob •JWL___ <br />Signature Title <br />(>-20 Gnl. <br />I fantl waih Water <br />Soap (li.ipoiteor | <br />| llloarh iiibI Wator <br />rxtui Icc Ihiga A l:ootl Conttihms nuist bo j <br />Storer/ 6 Inchon oil ol tflO ymtiiHl! i <br />18681?.. I lazolton Avenue | Stockton. California 95205 | T 209 468-3420 | F 209 464 0138 | www.sjcehd.com <br />IIIO 10-02 I’.TflQHof 11 IT."!’I?.". <br />0//.VI/ <br />( r / <br />Soap ami Water I I <br />Uro I xtlnrnilslKir i <br />| Ciittinn hoard