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Environmental Health Department <br />10. I am providing the fbHowing cold temperature control for the cold heading of potentially hazardoue foods below <br /> Three compartment slnL <br />OR <br />12. <br />**lmportant** <br />14. Completed by: <br />DateSignature <br />Health Permit <br />PtptrHaMToMto <br />So*dap«nwr <br />IpHpVWMM <br />Q: <br />rraiMmTai* <br />RMtVMMr SlMcn snd WMsr <br />Ice Cooler <br />TEMPevfiNTAPPPtg»#of11 <br />WaMMMrCMMrw <br />® Water supply dispenser with warm water at a minimum of 100°F (i.o. 5-20 gallon container with spigot). <br />One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />tanMMrbucM. <br />MmOikiMMrfer <br />Mattag <*Mh> <br />45’F (if food Is used the foltawing day. maintain below 41T temperature): <br />Qlce chests Refrigerator <br />O Refrigerated truck toe bath and tubs <br /> Other (specifv) ............. .. - <br />SAN JOAQUIN <br />COUNTY <br />4S[Psper towels and purrm-stvle soap container. <br />13. Hornes of rasponsble persons to be present In booth during a8 hours of operation: <br /> <br />AR 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 Io fssttval coordinator three weeks prior to <br /> <br />Title Date <br />2C <br />SmpvMWMt f- <br />li. lam providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />ficoth nwM be on <br />Concrete. AsphaH. <br />Ptywootl, or a Tarp. <br />S Three deep tubs (basins 6*8 inches minimum), one for soapy water, one for rinsing end one for a bleach <br />sdution (one tablespoon of bleach per gallon of water). <br />S Detergent, bleach, and wiping cloths (cleaning towels). <br />M Tub to store wiping cloths In bleach sotaticn. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />SMmoMQMMng <br />&M *» cw***» "»w *• <br />MMtf «4«MM MatuitfMKMf <br />y MMweMWator <br />.A <br />1868 E. Hazelton Avenue | Stockton, Califomia 952061 T 209 488-34201 F 209 464-0138 | www.8jcehd.com <br />EHD1MJ2 PWRSrfll <br />mnnr <br />«M0h <br />C 'O <br />Oarbaga <br />Can