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Environmental Health Department <br />10. <br />11. <br />OR <br />from utensil wash within my <br />12. <br />13. <br />Completed14. <br />[| I’aporllnndlowols <br />| Soap cSsporWM | <br />Ice Cooler i <br />[ Cutliiio lloord | ——- <br />1’iop.inn Stovo -. <br />( f-xlrn \ <br />Water <br />5 (Ml I land wash <br />Waslowatur Conlalnor <br />Garbage <br />Can <br />Snnltizor buckot- <br />bloach A water for <br />storing wiping dollis <br />Stenw w/ClinPing <br />Dish <br />Booth must bo on <br />Concretes, Asphalt. <br />Plywood, or a Tarp. <br />IIMm Water | | IMonch and w.itor | <br />JO <br />Health Permit <br />: ' T ■ • r."1 he , — if r_ <br /> - 209 468-3420 1 F 209 464 0138 | <br />11 ivil I ^Vl :IN I /xi i <br />I 'ngo fl of 11 <br />hjaqics of responsi] <br />“Important** i <br />^ration and operation. Return <br /> ^“signSfore Tit,G <br />5-20 Gal. <br />.-•I (tend wash Water <br />f xfr.i fco flags f. rood GotWnots must bo M <br />s'oied 6 Umhos ot! ot the fiioimdl J <br />1868 li. I lazollon Avenue | Stockton, California 9!>2.05 <br />I Illi 1G 02 ?!5C <br />07/3/1/ <br />| Hloach <br />______________..-K^y^-r-v.r..ZZZi.;X:'i. <br />| Soap and Watrw | | I <br />I Iro I 'xllauutelter | <br />SAN JOAQUIN <br />CO UN I Y <br />I am providing the following cold temperature control for tho cold holding of potentially hazardous foods below <br />45T (If food is used tho following day. maintain below 41 F temperature). <br />Ice chests ^Refrigerator <br /> Refrigerated truck O Ice bath and tubs <br /> Other (specify)— <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />P5} hree compartment sink. <br /> Three deep tubs (basins 6-0 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 />| Detergent, bleach, and wiping cloths (cleaning towels). <br /> Tub to store wiping cloths in bleach solution. <br />I am providing the following for adequate hand washing facilities, but separate <br />booth: <br />|\water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />^One separate tub (bucket or basin) for the collection of rinso/wastewatcr. <br />(j^apcr towels and RuinB^tyle_soaB container. <br />risible persons to bo present in booth during all hoursof operation. <br /> t \ 0 --------------- <br />^‘hl5ataPaK?s of <br />Sion SX <br />/fisayent^ , - - > <br />Date