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Environmental Health Department <br />io. <br />A* <br />1 <br />OR <br />12 <br />Water supply dispenser with warm water at a minimum of 100'F (i.e. 5-20 gallon container with spigot). <br />I One separate tub (bucket or basin) for the collection cf rinse/wastewater. <br />Paper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation:13 <br />•’Important'* <br />14 <br />k__-.t r.; He.rrt <br />aide- A-C WjtlX/ <br />«■ .••• E«:r;u w <br />Ice Cooler I <br />! <br />I <br />\ <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 follov/ing day. maintain below 41 “F temperature): <br /> Ice chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br />U Other (specify) <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />[j Three compartment sink <br />[. J 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 waler). <br /> Detergent, bleach, and wiping cloths (cleaning towels). <br />D Tub to store wiping cloths in bleach solution. <br />Garbage <br />Can <br />Booth must be on <br />Concrete Asphalt, <br />Plywood, or a Tam <br />5 Gal <br />GM <br />M.r-! A.ikb <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />________:----, <br />Healtn Permit <br />SAN JOAQUIN <br />C C ■ U M r Y <br />\’l <br />\Sons C'WW I —— <br />1868 L -lazei'.on Avenue | Stockton, California 95205 | T 209 468-3420) F 209 464-0138 | www.sjcehd.com <br />EHC 16-02 Pag* 8 o' 11 TEMP EVEN’ .-PP <br />3 •’ <br />Sc <br />i <br />IF1 <br />----------------------------------j <br />;<>i H.vc 1 >a. i . <br />bate <br />AoUda iJ <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, | Completed by: - <br />r-------------- <br />. ir <br />s •jw 'c< <br />.— ’i- l * ; 'l. t.k <br />r—~ <br />1 Propir- $« >»•• I - <br />' I <br />Signature ’ Title <br />.................................................... ... • - • ■ <br />I l A FoM Cortamin .Tu»tC« | <br />t'o/va f -cr-ot at orm* t’