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t <br />Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />□ Paper towels and pump-style soap container. <br />13. <br />"’Important** <br />Completed by:14. <br />Pao« Hand ToweU <br />Curtinfl Board <br />BleachPropano Slow <br />I <br />Propane Tank J Bleach and Waler <br />Fire txuiajuiUier <br />Ice Cooler J <br />TEMP EVENT M4'1868 E. Hazelton Avenue | <br />EHD 16-02 <br />06/1W19 <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Stemo w/Chalftng <br />Drsh <br />5 Gal Hand waih <br />WaHewalor Container <br />Garbage <br />Can <br />Sandier bucket­ <br />bleach S waler tor <br />slonng wiping dolhs <br />Booth must be on <br />Concrete, Asphalt. <br />Plywood, or a Tarp. <br />5-20 Gal <br />Hand wash Water <br />SAN JOAQUIN <br />COU N T s <br />hi<1 <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />45’F (if food is used the following day. maintain below 4 TF temperature): <br />Ice chests [3 Refogeiator <br />Q Refrigerated truck O Ice bath and tubs <br />□ Other (specify)_ <br />Ownir <br />Title <br />□ Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />3 One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />E*tn let B»gt I Food Conlai/wt mon bo <br />ilond 6 Inches off ot It* groundl <br />7 <br />ftnu WatorSoap and Walar I <br />I Soap dispenser <br />Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | ■^■ora'ehd <br />Page 8 of 11 —M-D — — A <br />Oft//?/ <br />Date' <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 evenvQ Z7 i ''y <br />(/.-4 <br />Signatiire <br />Names of responsible persons to be present in booth during all hours of operation: <br />Angela Duron___ ______________________ <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />S, Three compartment sink. <br />3 Three deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for a bleach <br />sojution (one fablespoon of bleach per gallon of water). <br />(STf Detergent, bleach, and wiping cloths (cleaning towels). <br />[SJZTub to store wiping cloths in bleach solution. <br />r~ ~.................. 1 <br />| Health Permit J