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Environmental Healtli Department <br />10. <br />11. <br />OK for rinsing and one for a bleach <br />12. <br />13. <br />“Important*' <br />Completed by.14. <br />I Pii.ic/ llmwl lowots <br />lllejcli nnu W.HniRmo Water <br />( Ixtra \ <br />Water <br />l ira I xtingiiHlior <br />Ice Cooler <br />SAN JOAQUIN <br />■■ ■ i •; , ; i' <br />Soap and Water.... <br />Slorno w/Chalfnig <br />Pislt <br />Garbage <br />Can <br />Booth must bo on <br />Concrete. Asphalt. <br />Plywood, or a Tarp. <br />5 Gal Hand warli <br />Waslcwator Contaoor <br />Saaitiznr Ixickol- <br />Ucach f- water tor <br />SlonnQ W’pwj ClotlW <br />Paper towels and pum|>slyjo soap container. <br />Names of responsible persons to bo present in booth during all hours of operation: <br />. Candace Peck_____—-------------------------------------------- <br />-S/6/; <br />Date <br />[ I’riipanc IihA <br />I am providing tho following items within my booth for the sanitary cleaning of food preparation utensil <br />( ^Three compartment sink. <br />[ J Throe deep tubs (basins 6-8 inches minimum), one for soapy water, one <br />solution (one tablespoon of bleach per gallon of water). <br />(zl-DetergentrbleaelvaHd-wiping-€lGlh&-(cloaning4owels).------------------------- <br />[ J Tub to store wiping cloths In bleach solution. <br />I am providing the following for adequate hand washing fadlltios, but separate from utensil wash within my <br />booth: <br />Water supply dispenser with warm water at a minimum of 100°F (i.c. 5-20 gallon container with spigot). <br /> One separate tub (bucket or basin) for the collection of rinse/wastewatcr. <br />- - ’ ..........................; <br />i:tlia Ice Moffs « l arxl ConWncis <nusf be <br />stoicd 6 inches c'l ol the onund' ! <br />18681: I Inzolton Avenue | Stockton. California 95205 | T 209 168 M201 P 20916'1 -0138 | www.SKjov.orgfohrt^ <br />Hl IO 16-0? |,a0o 0 u' 11 <br />06/19/19 <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />45T (if food is used the following day, maintain below 41’1- temperature): <br /> ice chests [^Refrigerator <br />[.J Refrigerated truck Ice bath and tubs <br /> Other (specify)------------------------------------------------------------------------------------------------------------------ <br />| Ctilteto llonrd | — <br />| f'roi’ano Stove <br />| Health Permit |'• <br />All food vendor booths arc 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 al all hours of <br />preparation and operation. Return original to festival coordinator throe wegksj)rior_to <br />tlys event. , ,_________________worker <br />Signature__________________Title <br />[ Soap duponvcf