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Environmental Health Department <br />11. <br />OR <br />12..; <br />13. <br />J- <br />**linpoi(ant‘* <br />14. <br />I’opcr Hnnd Twols <br />Soap dispenser <br />Propane Stovo nioacli <br />I, <br />Propane Tank <br />Flro GxlinflUlshor <br />Pnfio 0 of 11 <br />I <br />Fxttn lea flags A food Conlelneis must ho <br />itorod 6 Indios ol/oltho gioundl <br />Slornow/Chalfing <br />Dish <br />6 Gel Hand wash <br />Waslownler Container <br />Gaibage <br />Can <br />Sonlllrorbuckel- <br />bloacli S waler (or <br />storing wiping cloQis <br />Booth must bo on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />6-20 Gal. <br />Hand vmsli Wafer <br />’'I/ <br />10. <br />J <br />Ice Cooler <br />Title <br />7 <br />fllnsn Waler <br />Health Permit |J <br />l/| Waler supply dispenser with warm waler al 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 />Il Paper towels and pump-style soap container. • <br />I am providing the following for adequate hand washing^ facilities, but separate from utensil wash within my <br />booth: ■ ‘ '■ <br />aun^SANJOAQUIN <br />ipi’A | . -J -----COUNT Y------- <br />luiv^'' f'/<■’<> I Ilf Si l/IOWS IlCl'C. <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 41’F temperature): <br />[$dce chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify)• <br />Culling Board | <br />7 <br />Soap apdWalar <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />. 1 • <br /> Three deep tubs (basins 6-8 inches mlnin'ium), one for soapy waler, one for rinsing and one for a bleach <br />/Asolution (one tablespoon of bleach per gallon of water). x \ <br /> Detergent, bleach, and wiping cloths (cleaning towels). <br /> Tub to store wiping cloths In bleach solution. <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420) F 209 464-0138 | www.sjcehd.com <br />n7n/r/'0? Pn(l<»Dof11 TEMP EVENT APP <br />All food vendor booths are subject to inspection. Please make a copy of tills 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. Retunuoilqinal to festival cooidinator throe weeks prior to <br />this event. /t t fl ' . . ~ <br />Completed by: /VUzZ __/fa/c) <br />Signature Title Date <br />Uloachand WalM <br />■ *b\ <br />Narn^of re^i^sib^ perso^to^be^pr^s^nt^booth during all hours of operation: