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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />13. <br />"Important** <br />14.Completed by: <br />Signature Title Date <br />5 20 Onl. <br />I'upor llond Tenvois <br />| Hoard |I <br />loo Cooler <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <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. <br />S Gul I laud wash <br />Wastowalor Coul.ilnor <br />SnullMor buckot- <br />bloach A wntor for <br />slmlUQ wiphiy cloths <br />Booth inust be on <br />Concroln, Asphalt, <br />Plywood, or a Tarp. <br />1866 I -. Hazelton Avenue | Stockton, California 952051 T 209 468-3420 | F 209 464-0138 | www.sjcohd.com <br />IWtOO? I’.ifjo 0 of 11 If Ml'IVIN I APP <br />II//.1/I7 <br />I >h.> lev fl.iiys A I ootl Cont.ilnois must ho <br />uloml Ci inchos oil ollho fiioumll <br />Storuo wA)hii(lniQ <br />Dish <br />Garbage <br />Can <br />SAN JOAQUIN <br />COUN I Y <br />(it ••in tic ss qi itv. s 'i‘ i c <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 Refrigerator . / j <br />[ . J Refrigerated truck ( J Ice bath and tubs / ' <br /> Other (specify)_________ <br />Water supply dispenser with warm water at a minimum of 100’F (i.e. 5-20 gallon container with spigot). <br />jX[ One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Paper towels and pump-stylo soap container. <br />I loalth Permit p <br />I. | Detergent, bleach, and wiping cloths (cleaning towels). <br />| J Tub to store wiping cloths in bleach solution. <br />l am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />fl Three compartment sink. <br /> Throe 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 />> /V/9 <br />| I'rop.inn Slova <br />| I 'loiMino Tnitfc <br />Names of responsible persons to be present in booth during all hours of operation: <br />___^i/ffil\fc ! ____________ <br />Dluucli <br />Soup nml Wntor Hiu.io Wntor lllonrh nod Wntor <br />I ho I xtlOQulntior <br />| :;n;i|i <li.;po:r.or