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Environmental Health Department <br />10. <br />for nosing and one for a bleach <br />12. <br />I <br />13. <br />Health Permit .• <br />P»per Hand Toovta <br />Soaoditt«nMK <br />i <br />BtMchMWmr <br />Ice Cooler <br />SMrno Ojdnj <br />DUh <br />SaMUar bucMk <br />btoadiA water fcr <br />■tonng wiping ctotlU <br />SAN JOAQUIN <br />*■ - COUNTY - - <br />Garbage <br />Can <br />-. <br />SGaiHandwmh <br />WauewMK Ccnlaow <br />$-20 G& <br />Hand was* Water <br />Sli <br />_Z <br />Rm»a Water <br />Booth must be on <br />Concrete. Asphalt, <br />Ptywood. or a Tarp. <br />•---------- / <br />11 ■ i am providing the foOcwing it< <br /> Three compartment sink <br />OR <br /> Three compartment sink <br />Q Three deep tubs (basins 6-8 inches minimum), one for soapy water, one <br />solution (one tablespoon of bleach per gallon of water). <br />Q Detergent, bleach, and wiping cloths (cleaning towels). <br />-B^Tub to store wiping cloths in bleach solution. <br />I am providing the following for adequate hand washing facilities, but separate from utensil <br />booth: <br /> Water supply dispenser with warm water at a minimum of 100 F (Le. 5-20 gallon container spig <br /> One separate tub (bucket or basin) for the collection of nnse/wastewater. <br /> Paper towels and <br />ii|i <br />I <br />s <br />fj <br />I Signature <br />_z <br />Soap and Water <br />I <br />14. Completed by. <br />p. ’^"wr ww ,AV4>rw'wrB^i’nxfP!!wiw <br />ftea *c» 4 Food Contaw*! .nuar t» j <br />•teted 4 mrtw teT o< Ite straunrf <br />^Ha^hon Avenue | Stockton, California 95205^ 209 468-3420 ( F 209 464-0138 | www.eisov.org/end <br />’9 TEWEveNTAPP <br />’ anr\^vlding the following cold temperature control for the cold holding of potentially hazardous foods below <br />** F (if food Is used the following day, maintain below 41 *F temperature) <br />«lcc chests Refrigerator <br />U Refrigerated truck Q Ice bath and tubs <br /> Other (specify) (-^1 fy-CKYlS ------------------—” <br />lems within my booth for the sanitary cleaning of food preparation utensrl <br />e $oap container. <br />Names of responsible persons to be present in booth during all hours of operation <br />\oC\^<X,^V,<Xz 4 l.tfs ——------ ---------------- r— --------- <br />“Important” AB food vendor booths are subject to inspection. Please make a «>py^of th® appfcabonTin <br />preparation for this event. A copy of this checklist must be in the booth at ail hours of <br />preparation and operation. Return original to festival coordj.nator_th.ree weeks prior to <br /> <br />Title Date