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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />[X] One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />E) Paper towels and pump-style soap container. <br />13. <br />“Important** <br />14. <br />Jl <br />Ptpw H*r»d Tcweb <br />CUtrtj Board <br />rrepe.-.o Siova <br />Prapana Tcnk <br />OJeKh *nd Water <br />FVo Exfino^HW(yr <br />Ice Cooler <br />Pupa 8 of 11 <br />Names of responsible persons to be present in booth during all hours of operation <br />Michael Porter <br />Sumow&Mttna <br />DWi <br />5 Gal Hand wslh <br />W*»i<r*Tit«r Ccnuloar <br />S-20 Cd. <br />Hand u-aih Water <br />Garbage <br />Can <br />Booth must be on <br />Concrolo, Asphalt, <br />Plywood, or a Tarp. <br />SrrtarftAKkcl- <br />Hatcti & water for <br />Blortngvrlpinodoeii <br />_z <br />Soap rod Wcter <br />/ <br />Rlnio Water <br /> Water supply dispenser with warm water at a minimum of 1 GOT (i.e. 5-20 gallon container with spigot). <br />I am providing the following Items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />[X] Three deep tubs (basins 6-8 Indies minimum), one for soapy water, one for rinsing and one for a bleach <br />solution (one tablespoon of bleach per gallon of water). <br />El Detergent, bleach, and wiping cloths (cleaning towels). <br /> 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 />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />EHD 16-02 . PnoaBofll TEMP EVENT APR <br />07/3/17 <br />/ 1 Exira Oxqi 4 Fcoi Cooltlncrs mjz! bo <br />' I Uairi0l:Kfn!CrtCsfl/!Ocruuxn <br />All food vendor booths are subjed 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 />this.evontr-. , <br />r, ..,,.. , <br />Health Permit I <br />Sotp dfpanitr | --------- - <br />SANJOAQUIN <br />"ILJilZ •-----COUNTY------- <br />Grcofiicss yioivs hnr<. <br />1 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 41aF temperature): <br />S Ice chests Refrigerator <br /> Refrigerated truck El Ice bath and tubs <br />O Other (specify)_________ <br />EMte <br />Wa'.w