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Environmental Health Department <br />10 <br />11 <br />OR <br />J <br />12 <br />13 <br />14. <br />r \ <br />Twr,' <br />rV'A* v-4*.- <br />0 <br />I '.talHsWMV- L <br />i Cc-,*»,'w I <br />rfM? rvEsn *pp <br />_ ( J UlvVM r__ <br />’ Title <br />1 am providing ine following for adequate hand washing facilities, but separate from utensil wash within my <br />booth <br />C«n <br />• & -.tte- •» <br />SAN JOAOUIN <br />------COUNTY------- <br />^Ice Cooler <br />o <br />I ayi providing the following items within my booth lor the sanitary cleaning of lood preparation utensil <br />P] Three compartment sink ■ <br />Q] Three deep tubs (basins 6-8 inches minimum) one for soapy water one for rinsing ond one for a bleach <br />Zojut-on (one tablespoon of bteacn per gallon of water) i \ / • / <br />2; Detergent, bleach, and v.-iping cloths (cleaning lowi'l -' I ________I I----------------’ <br />''ET Tub to store womg doths in bleach solution <br />|---- <br />.s .. L,' I <br />» ki r-» <br />••*sU | <br />A copy of this checklist must be tn the booth at all hours of <br />R< turn original to festival coordinator three weeks t rior to <br />& <br />Date <br />j { V> <br />I am providing the toilowing cold temperature control for the cold holding ol potentially hazardous foods below <br />45*F (if food is used the following day mamlaln below 4 IT temperature) <br /> Ice chests Refrigerator <br /> Refrigoraied truck O It-® an(1 ,ut>s <br />Q Other (specify) ____________ <br />_ I rfc-J- | <br />i tn V« . —■ O »*« 6« <br />t kiwou < Y fw <br />1868 E Hazetlon Avenuo I StocMo- Califo<ma 95205 | T 209 468-34201 F 209-'.G 10138 | .v»v..-^go, org'ehd <br />eno h-02 p«8»»'* ’1 Fy£-‘<T *! <br />cv-79 wn <br />Waler supply dispenser with warm water at a minimum of 100*F (i.e 5-20 gallon container with spigot) <br />/j One separate tub (bucket or basin) for the collection of nnse/wastewater <br />Paper towels and pump-styte soap container <br />Nairn's of responsible persons to be present in booth during all hours of operation <br /> <br />’"Important'* All food vendor booths are subject to inspection Please make a copy of this appheaton in <br />preparation for this event <br />preparation and operation <br />thia ev <br />Completed by <br />BocV rr4,»: r* on <br />Corocki V.pfun ! <br />P*w«x>d o> a 1» p <br />Health Permit !