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Environmental Health Department <br />10. <br />11. <br />OK <br />12. <br />13. <br />“Important** <br />14.attire <br />| I'nporllnnd'lowOlsI| Soap dsponsor | -- <br />I <br />Ico Cooler <br />| Son <br />Hro I xlinqulUior <br />Slonio w/Clinlfi'ifl <br />Diali <br />5 Gnl Hand wish <br />V/aslowalor Coiitnlnor <br />Gnrbago <br />Can <br />Sanitizer bodtot- <br />bloadi & water (or <br />storing wiping cloths <br />|ior supply dlspenserwlth wane water at a minimum of WF (i.e. 5-20 gallon container with spigot). <br /> One separate tub (bucket or basin) for the collection of rinse/wastewator. <br /> Paper towels and p_ump-stylc_soap container. <br />‘■ggc --------- -- <br />| I’lOp.tne Iitnk <br />| Cutting Honrd | • > <br />I'rnpnnoStovo I , 1o nloaclt <br />| | llniao Water | | lllonch nnd Wah r | <br />( lortrn \ <br />Water I <br />SAN JOAQUIN <br />COUNIY <br />! am orovidinq the' following cold temperature control for the cold holding of potentially hazardous foods below <br />45JHif foodis used thG fo|lowin9 day^maintain below 41 F temperature). <br />[vtkechests Q^efrigerator <br /> Refrigerated truck fo®bath and tubs <br /> Other (specify).. ~ <br />I anXroviding the foiling items within my booth for the sanitary cleaning of food preparation utensil <br />[vTl hree 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 por gallon of water) <br />[’ I Detergent, bleach, and wiping cloths (cleaning towels). <br />[ j Tub to store wiping cloths in bleach solution. <br />I am providing the following for adequate hand washing facilities, but <br />booth: <br />Z/M il^. - <br />| Soap nnd W.-rtor | <br />r <br />Booth must bo on <br />Concrolo, Asphalt. <br />Plywood, or n Tarp. <br />separate from utensil wash within my <br />slottxl 6 Inclios oil <>/ //to (iiotilHlI . <br />18681 . Hazelton Avenue | Stockton.^^ ^Sr- <br />I III) 16 02 <br />07/3/17 <br />| Health Permit p <br />Airm^F^are subject to htspoctiom Please mate a ^pytf tte appheaton <br /> <br />^aSlon and'operZn: <br /> UilSnC/^1 Dv) ____S.jj2h-^'3 <br />Completed by:---------------------------------------------------------- " Tjt|e Date <br />5-20 Oal. <br />I Innil wash Water