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Environmental Health Department <br />w. <br />11. <br />OR <br />12. <br />E Water supply dispenser with warm water at a minimum of lOO’F (i.e. 5’20 gallon container with spigot). <br />S One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Q Paper towels and pymi zlesaap container. <br />13. <br />““Important <br />14. <br />Si<re <br />Health Permit <br />PKpnf H«nd Towoln <br />tJopooMy <br />CuiunfilkMrd <br />DFMetiPropan® 3tovo <br />OhMKh Wat* <br />»•** LrtnlOpWi* <br />______Wl <br />3ojp <br />EHD lfi-02 <br />07/3/17 <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Crrm toe L Rxxf C<xHrf*i»r> man 09 ttonxi 5 rKt>9l Off of oro-ji'i1 <br />Su*nosMtCha!rin« <br />CMHi <br />5 Qnt HenC <br />Wiwcwnte* Goctttow <br /> Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Sorvtlcer bwCket- <br />Otriacri a *w(<x ky <br />r.onng M«p><x> dOChi <br />Cxtri <br />Water <br />SANJOAOUIN <br />’------COUNTY------- <br />’ C-<::}tnii :i 9re -vs h* r». <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 41T temperature): <br />Q Ice chests ^[Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify)........................................................... <br />Rkino Wntw <br />Tittepnude r <br />WO G*F <br />Aif 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- R*htfP original tojp^tival coordinator three weeks prior to <br />this event <br />Completed by: <br />T»nk <br />■ <br />ttF <br />Gamaf)© <br />Can <br />Date <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />Q Three compartment sink. <br />E^ree deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for a bleach <br />sohjiion (one tablespoon of bleach per gallon of water). <br />Efpdtergent, bleach, and wiping cloths (cleaning towels). <br />0Tub to store wiping cloths in bleach solution. <br />A-JI <br />Ice Cooler S <br />1868 £. Hazelton Avenue | Stockton, California 95205 | T 209 468«3420 1 F 209 464-0138 | www.sjcehd.com <br />Z' ‘Z ■: 22 Ftfla 8 0/11 TEMP EVENT APP <br />Names of responsible persons to be present In booth during all hours of operation: <br />rwpr-\p M/^fC\-s> |Q?V\ tA v\6