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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />“Important** <br />Completed by:14. <br />Pope; Hand Towels <br />nioadi <br />f’rop.ino Stovo <br />I <br />TiirK <br />11(0 t-XllH'JlHShW <br />TEMP EVENT APPPago n of 11 <br />Extrn <br />Walof <br />Garbage <br />Can <br />Son>li7er buckot- <br />I>loach4w3t«r(or <br />storing wiping cfoihs <br />5 Goll land wash <br />Wnslowator Conl.iincr <br />5-20 Onl. <br />Handwash Wolor <br />Booth must boon <br />Concrclo, Asphalt, <br />Plywood, or a Tarp. <br />Slcmo w/Chnfr.no <br />Oish <br />SAN JOAQUIN <br />( I M I I i I Y <br />IP WM/ <br />Title <br />r-yr, ■ <br />Ctiu Ko H.igs rood Contamcn mutt bo <br />itoKd 6 inches oil ollhe gtcumll <br />Ice Cooler ' <br />7 <br />Soap and Waler <br />; v ry-ry.pr. Xi- <br />Health Permit H <br />Soap dispenser I <br />IF <br />2 <br />Hinso Wolor <br />I am providing tho following cold temperalure control for the cold holding of potentially hazardous foods below <br />45°F (it food is used the following day, maintain below 410F temperature): <br />•jZJ Ice chests Refrigerator <br />[71 Refrigerated truck LJ lce bath and tubs <br /> Other (specify) __ ___ ______——— <br />1068 E Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcchd.com <br />(■hdig-o? Pana nor 11 ii.mi uveni <br />07/3/17 <br />=fL <br />I am providing the following items within my booth for tho 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 />Q 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 from utensil wash within my <br />booth: <br />'QJ 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 rinse/wastewater. <br />(if Paper towels and pump-style soap container. <br />13 Names of responsible persons to be present in booth during all hours of operation: <br /> He v —------ <br />All food vendor booths are 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 at all hours of <br />preparation and operation. Return original to festival coordinator three weeks prior to <br />this event. . : /) . .7 .. / i <br /> Signatory Title D^te