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<br />irdous foods below <br />10. <br />11. <br />OR <br />12. <br />13. <br />"Important** <br />Completed by:14.Data <br />Health Permit Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />Bleach <br />Propane Stove <br />Propane Tank <br />Bleach end WaterFUne® WaterSoap and Waler <br />Fre ExUngUshof <br />F 209 464-0138 | www.8jcehd.comStockton, California 95205 | T 209 468-3420 |temp event appPage 8 of 11 <br />SB <br />1B68 E Hazelton Avenue | <br />EHD 1M2 <br />07/3/17 <br />Garbage <br />Can <br />SsnMiwbudwt- <br />ble«ch&w»t«riw <br />coring wiping cl«M <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Stemo w/Chaffing <br />Dish <br />5-20 Gal. <br />Hand wash Water <br />SAN.JOAOUIN <br />-------COUNTY------- <br />Greatness rjrows here. <br />providing the following cold temperature control for the cold holding of potentially hazai <br />Ig | <br />Ice Cooler <br />' U>«r|S' <br />I am p_____a__________„ _______r. <br />45°F (if food is used the following day, maintain below 41 °F temperature): <br />'2Llce chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify) ________ _ _ _______ <br />Environmental Health Departm <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br /> Three deep tubs (basins 6-8 Inches minimum), one for <br />solution (one tablespoon of bleach per gallon of water). <br /> Detergent, bleach, and wiping cloths (cleaning towels). <br />0 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 />■ . . ■ ' ■ ' <br />.uujovr rv Please make a “pVL^ISraPH h^i^fof <br />A copy of this checklist must be in the booth at alI hours of <br />Return original to festival coordlnMor weeks prigr jo <br /> <br />'Daft/ <br />■ <br /> water supply dispenser»» ww, water at. mhlmum of 100-F (I... WO9*- <br /> One separate tub (bucket or basin) for the collection of rinse/wastewater. <br /> Paper towels and pump-style soap, container. <br />Names of responsible persons to be present in booth during all hours of operation: <br />soapy water, one for rinsing and one for a bleach <br />All food vendor booths are subject to inspection <br />preparation for this event, <br />preparation and operation. <br />v Signature <br />original to festival coordinatgr th! <br />J <br />Title <br />6 G»l Hand w»h <br />WMtawaler ConWner