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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />13. <br />‘‘Important** <br />14. <br />f’apor IImid Townls <br />IHoachI'ropntioSlovn <br />Hinso W.itor lllnnch ruKlW.ilor <br />I <br />Water supply dispenser with warm water at a minimum of WOT (i.o. 5-20 gallon container with spigot). <br />| One separate tub (bucket or basin) for the collection of rinso/wastcwatcr. <br />Paper towels and puinphstyle_sp_ap container. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />17] Ihrcc 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 />O Detergent, bleach, and wiping cloths (cleaning towels). <br />(Z1 Tub to store wiping cloths in bleach solution. <br />Stwno wfCItofliiio <br />OWi <br />.'iCiil ILuul wnsh <br />Wastnwnlnr Conl.ilmr <br />Garbage <br />Grin <br />Snnltlzar buckol- <br />lilonch A wnlor for <br />Storing w'pliiu clolhn <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464 0138 | www.sjcohd.com <br />IHDIG-O? I’ngoOofll 11 MP hVI NI Al'P <br />0//3/I7 <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />.Jx^Three compartment sink. <br />SANJOAOUIN <br />COUNTY <br />( '.I .•<»I -i <)foi,". lit '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 JS^Refrigerator <br />I I Refrigerated truck | ’ | Ice bath and tubs <br />Q Other (specify).__________ <br />I <br />I <br />5-20 Gal. <br />I land wosli Watnr <br />Ice Cooler | <br />Names of rosponsiWe persons to be presonHn booth during all hours of operation: <br />3 > -------------- <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 />Completed by\x''^" <br />I I lealth Permit <br />[ Prop.mo l ook <br />| Sonp nn<l Wnlnr <br />lire liKthflulshor <br />'J Signature <br />| Soap disponsor <br />Sfl Booth must bo on <br />I / Concrclo, Asphalt, <br />t'tti.i fee flags A rood CotUulnotit mist be <br />slored fi Mitis oil ol tho wound! <br />11 | ?..y <br />Date <br />| (AiltiiMI llonrd <br />Title