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Environmental Health Department <br />11. <br />OR <br />12- <br />13. <br />.. SWniqw/Ohimng <br />P Soap dlsponnai~[ <br />u <br />. .il <br />Hri> Exlinguisher <br />TEMP EVENT APRPane 8 of il <br />\ <br />HlBadrapdWatqr <br />•' ' .1 <br />Exfm tee flags i Food Containers mi/sl be <br />stored 6 Inches ollol Ihn ground! <br />Rooth njusl be on <br />ConcfBte; As'plirilir <br />Plywood, or a Tarp. <br />I ahi providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink.. <br />Cl Three deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for a bleach <br />solution (one tablespoon of bleach per gallon of water). . <br /> Detergent, bleach, and wiping cloths (cleaning tow'elS), j\i / A <br />(71 Tub to store wiping cloths In bleach.solution, • /TA <br />I am providing the following for adequate hand washing facilities,, but separate from utensil wash within my <br />booth: <br /> Water supply dispenser with warm water at a minimum of 100',l- (i.e. 5r20 gallon container with spigot); <br /> Ope separate tub (buckct.or basin) for the collection of rinse/wastewater. <br />Paper Hand Tcwals <br />45°F (if food Is used the following day, maintain below 41 °F temperature): <br /> Ice chests Refrigerator > <br /> Refrigerated truck Ice bath and tubs <br />O Other (specify)_______ f.____ <br /> <br />Garbage <br />CeUT <br />Health Permit <br />foAt? <»• <3 LQ-/-/4 <br />**impp‘rtaht*'t <br />Culling'Roard j <br />I’rppqpaStoyo „ <br />Soap nnd Waler <br />/ <br />Ice Cooler <br />~nr" <br />RlnSaW^ler <br />1 pasefe <br />Blnach <br />Ssnllke/hucfcol- <br />. bleach swuiertor <br />slonng wiping cloths <br />1868 E. Hazelton Avenue | Stockton, California 95205 j T 209 4'68-3420 | F 209.464-01.38 | www.sjcehd.cpm <br />EHD-16 ^ Page 8 of il TEMP EVENT <br />07/3/17 ‘ <br />SANJOAQUIN <br />r to' ■) —- COUNT Y---■ <br />Greolness grows here. <br />10. I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br /> Paper towels and pump-style eoap container. <br />Names of responsible persons to be present in booth during all hours of operation: <br />\Jg c,cc ca, <br />All food vendor booths are subject to inspection. Please nfoke 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 event. /) / / <br />Completed b/: ---------- ■L .; .. C‘;- <br />Signature Title Date <br />sao Uni. <br />Hand wash W-T-or <br />£