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Environmental Health Department <br />10 <br />11 <br />OR <br />12 <br /> One separate tub (bucket or basin) for the collection of rinse/wastewater <br />13 <br />••Important** <br />Completed by: 14. <br />Signature <br />Health Permit <br />CxAng Btxrd 1 iPmcxrw Str»* <br />it LJ <br />F ** ( xhrvMha* <br />Ice Cooler <br />P*ge » rt 11 <br />tun tc* Bag> * fmd Cmtu/tan mutt tn <br />•TerW * Incttn otl o/ afr> gr«um(' <br />(r»a <br />Wat* <br />Sarvkrv <br />Maaen * <^*ar m <br />l 1 a j <br />S«mo •r*CK*'">gIW) <br />5-70 Gn <br />HOTdrah WMar <br />Boodi must be on <br />Concrete. AsphaH. <br />Plywood or a Tarp <br />EHD 16-Oz <br />O7«2!/?O24 <br />5 Ga. HMTd a wh <br />WAaacMTr*- C<rl*n» <br />Gartwge <br />Can <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />l^Water supply dispenser with warm water al a minimum of 100’F (i e. 5-20 gallon container with spigot). <br />I am providing the following cold temperature control for the cotd holding of potentially hazardous foods below <br />45T (if food is used the following day, maintain below 41’F temperature): <br />Q loe chests Refrigerator <br />^Refrigerated truck f~| toe bath and tubs <br /> Other (speafyk <br />SAN JOAQUIN <br />C O U N 7 v <br />QlvVUv- <br />Title <br />Paper towels and pump-style soap container <br />Names of responsible persons to be present in booth during all hours of operation <br />L-I Sm ___ _____________ <br />Ail food vendor booths are subbed 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 />Z-S <br />Date <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />Three compartment sink <br />Q Three deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one tor a bleach <br />solution (one tablespoon of bleach per gallon of water). <br /> Detergent, bleach, and wiping cloths (cleaning towels). <br /> Tub to store wiping cloths in bleach solution. <br />1868 L Hazelton Avenue | Stockton California 95205 | T 209 468-3420 | F 209 4 64-0138 | www sjgov org.oho <br />E.:c XCZ Page Hot 11 1EMP EVENT Al-V <br />■Uu,_rr./ <br />| | ----- \ <br />haUoLJ