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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />[ vpT’aper towels and p.ump-styje soap container. <br />13. <br />14.Completed by: <br />Title DateSignature <br />I I II 'iipor I liuid Towols <br />Cutting Boanl <br />[ Hlnach <br />I ’rop.ino Stove <br />lllo.i. h nnd Wntor <br />I Im I xlhinuhilior <br />I co Cooler <br />II Ml* I VI NT API’ <br />F l Water supply dispenser with warm water at a minimum of 100T (i.e. 5-20 gallon container with spigot). <br />[ i^fOne separate tub (bucket or basin) for the collection of rinsc/wastcwatcr. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />[J Three deep tubs (basins 6-8 inches minimum), one for soapy waler, one for rinsing and one for a bleach <br />solution (one tablespoon of bleach per gallon of water). <br />[ | Detergent, bleach, and wiping cloths (cleaning towels). <br />( j Tub to store wiping cloths in bleach solution. <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />I I Three compartment sink. <br />5 Gul I Iniul wnsh <br />W.istow.itorConlnltior <br />Sanldzor buckol- <br />blo.icli ft wntor lor <br />Storing wiping dothri <br />Booth niiisl be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />I xba leu ll.ujs & I ood Conlalncis mus( fro J <br />slaioil 6 Indios off of the groundl -.1 <br />Garbage <br />Can <br />I lealth Permit p <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 />SANJOAQUIN <br />C OUN TY- <br />(. i <,(ii ..(•!.■> <).■ .rp. •. h‘ < e <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 />[ kjdcc chests O Refrigerator <br />IJ Refrigerated truck | J Ice bath and tubs <br /> Other (specify) <br />Kinso W.ilxr | <br />( l-xlrn \ <br />I Walot <br />| Soap dispoascr | . <br />.P.•»> ----< • -nrrr <br />1868 I ;. I lazollon Avenue | Stockton, California 95205 | T 209 468-3420 | F 2.09 464-0138 | www.sjcohd.coni <br />HID 1(5-02 P.IC|C 11 of 11 C ":’! C1! <br />07/3/17 <br />**lmportant** <br />Names of responsible persons to bo present in booth during all hours of operation: <br />^J7x c <br />5 20 Gnl. <br />I l.iiul v/nsli Walor <br />i .1 I. <br />J | Soap and Walnr 11 <br />Slomo w/Chnffing <br />Diab | <br />| PropMO Tank