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Environmental Health Department <br />10. <br />M(XcV\in& <br />11. <br />OR <br />12. <br />13. <br />‘‘Important** <br />14.Signature <br />I | Sonp cSsponsw | <br />| Ittonch | <br />_____ <br />Title <br />Slomo w/Chnffi'O <br />lush <br />!> Gnl I land wnsli <br />WaMowalor Coiit.ilnor <br />Snnltizof buckol- <br />Hoach A wator tor <br />storing wiping dolhs <br />Garbage <br />Can <br />Booth must bo on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />,, but separate from utensil wash within my <br />HvcaVr <br />| RlnsoW.itor <br />tF _ J^A-L-j'rV <br />nlor | | liloacli nnd Wntor <br />Ice Cooler j <br />i. Return original to festival coorcllnatorjhroe week.s.prior tg <br />'Date <br />5-20 Gnl. <br />I land wash Wntor | <br />I lealth Permit <br />| I’li'p.inolnnk <br />'''! Li ‘ <br />| Oitkng lionrd j ----- <br />| 1'rop.uto Stovo . <br />I xlrn lea ll.rfis K I bort Conlnlucis must bo I' j i <br />stored 6/ric/i>w all ol Iho niouiull Li I <br />1868F.ttazoHonAvom.el Stockton'California 902(15 | T 209 468-3420 | F 209464-0138 | www.sjcehd.com <br />I Uli 16 07 I .'fln <’ <br />| I’aporllnndTowols | <br />| r.onp and W.ilor <br />_ l lro I xliniinlshor <br />SAN JOAQUIN <br />COUN I Y • <br />( >i ••..! nr- UM"'-. In <br />I am providing the following cold temperature control (or the cold holding of potentially hazardous foods below <br />45T (if food is used the following day. maintain below 41 F temperature). <br />L’J Ice chests LJ Rofrigerat°r <br />[Zl Refrigerated truck LI Ice bath and tubs <br />Other (spocify).^.V^^^_A^--^WID.. <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />^| Three compartment sink. <br />□ 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 water) <br />M Detergent, bleach, and wiping cloths (cleaning towels). <br />iyj Tub to store wiping cloths in bleach solution. <br />I am providing the following for adequate hand washing facilities, <br />O-e- 5-20 gallon container V4 W <br />04 One separate tub (bucket or basin) for the collection of rinsc/wastewator. <br />Paper towels and pum^style soap container. <br />Names of responsible persons to be present in booth during all hours of operation: <br />---------------------------------—-———— <br />’All food vendor booths are subject to Inspection. Please make a copy of this■ ■W,i^i"n 'n <br />nmnnration for this event A copy of this checklist must bo In the booth at all hours of <br />preparation and operation. Rotum^gmaljojgstiv^^ <br />this event. <br />Completed by: <br />2.rr.:— <br />it p