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Environmental Health Department <br />to <br />11 <br />OR for soapy water, ono f rin ■ . r m : ■ ■ < tii-'-.h-r <br />12 <br /> Waler supol\ dispenser with warm water at a minimum of WOT (l.e 5-20 gallon cont liner with spig / <br />n One separate tub (bucket or basin) for the collection of rinse/wastewatei <br />Paper towels and purry stylo soap container <br />13. <br />14. <br />TitleSignature <br />Health Permit <br />Pace- ham <br />Soun dl»pi»isof <br />C &o»'^ <br />BleachRrppane b-L..- <br />tr-catib-w Toak. <br />Fue L AtuiquiBl.ui <br />Page (! uf 11 <br />L <br />I tin fee i COM 'Iluit be <br />Lbj-oa 6 - z-tV^o ytui'J' <br /> <br />' >.<11 land w > .h <br />WMIOWAlet Contasivi <br />Booth iri.st be on <br />Concrete Asphalt <br />Plywood or a Tarp <br />I All l-l <br />Woloi <br />ft- 20 Gal <br />H.i’nl windi Walin <br />Garbage <br />Can <br />Slsino wfChaffing <br />Dish <br />I am providing the following items within my booth for the sanitary cleaning ,,f r ■’ I'1’ " ll'“ ■ "l- '! <br /> Three compartment sink <br />SAN JOAQUIN <br />-----COUNTY------ <br />All food vendor booths are subject to inspection. Please make a copy of this app cat <br />preparation t^r this event. <br />preparation <br />this event. <br />Completed by: <br />■ <br />■ <br />Hlfi»ii Wu<w <br />Ice Cooler <br />Samt.-r. hv. XSC <br />\ ».:'| • fw <br />itocnij w-ni^j <br />’•Important” <br /> Three deep tubs (basins 6-8 inches minimum), one <br />solution (one tablespoon of bleach per gallon of water) <br /> Detergent bleach, and wiping cloths (cleaning towels). <br /> Tub 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 />I am providing the following cold temperature control tor the cold holding of potentially hazardous foods below <br />4b I (iffood is used the following day maintain below 41 I temperature ) <br /> Ice chests Refrigerator <br /> Refrigerated truck [ I Ice bath and tubs <br /> <br /> Other (specify)^ ____ <br />A cony of this checklist must be in the booth at al b.:.,-s of <br />id operation Retiuii original to festival coordinator three weeks prior to <br />_______ <br />Date <br />1868 E. Hazelton Avenue | Stockton California 9520b | T 209 468 3420 | T 209-164-0138 | www s>iov org'etid <br />EHD 16-02 pdflefloflt 1 EMI’ L VENT APP <br />06/29/2023 <br />b-onp u'nj Wulu <br />|! I <br />I Illir.VH I yv.np. <br />Names of responsible persons to be pi esent in booth during all hours of operation__San A