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Environmental Health Department <br />OR <br />I <br />12. <br />I"] Water supply dispenser with warm water at a minimum of 100oF (i.e. 5-20 gallon container with spigot). <br /> One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />13. <br />14.Completed by. <br />DateTitleSignature <br />Paper Hand Tends <br />Cuffing Board <br />J B1B3CT)Propane Stave <br />ftspancTank <br />Bleach and WaterRinse WateSoapsndWstef <br />Fire E»vy richer <br />Ice Cooler <br />TEMPEV34TAPP <br />.■^jAasgfe^w-e'g-^-aaaaK-; <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />5-» Gdl <br />btend wwhWster <br />Garbage <br />Can <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />5 Gai Hand ws=h <br />Wstawtacr Ccniua«3 <br />SHmowrCbaCfing <br />Sacsfiier bctfcst- <br />water for <br />storing wfcing doth* <br />SAN JOAQUIN <br />------COUNTV------- <br />An a T) . <br />“Important* <br />Ctaa tan Bogs t Food Ctntacievs <ncd te <br />«ton>d ft tKt»s off tng gntntft <br />Health Permit * <br />11. I am providing the foltowing items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />■ <br /> Three deep tubs (basins 6-8 indies minimum), one for soapy water, 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 />Q Tub to store wiping cloths in bleach solution. <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 foe following day, maintain below 41 °F temperature): <br />O Ice chests Refrigerator <br /> Refrigerated truck .Sjce bath and tubs <br />O Other feoedfv) ........................... — <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468'3420 1 F 209 464-0138 | www.sjgov.org/ehd <br />EHD 18-02 Page 8 flf 11 .-MT <br />osrarcozs <br />Paper towels and pump-stvie soap container. <br />Names of responsible persons to be present in booth during all hours of operation: <br />. > JoSc _______ ______ _______________ <br />. MqaCvi . ------------------------------------------------------------ <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 foe booth at all hours of <br />preparation and operation. Return original to festival coordinator three weeks prior to <br />this event