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SAN JOAQUIN <br />11 <br />OR <br />S Water supply dispenser with warm water at a minimum of 100nF (i.e. 5-20 gallon container witfi spigot) <br />S One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Paper towels and pump-style soap container <br />13 <br />••Important" <br />Completed by 14 <br />Signature Title Date <br />I'm** h»r<i <br />5<)«:a,iP'>Xi*W t'- '>■« <br />f rw ( <br />i Ice Cooler <br />: am omvtmng 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 41T temperature) <br />G ice chests Refrigerator <br />Refrigerated truck ice bath and tubs <br />O Other (specify)_____________________________________________________________ <br />t •t’a fi<n)c 4 / <XX3 (.tvitwn mull bn <br />iJ-.nri t ‘-■ir/vrl <0 of "w <br />All food vendor booths are subject 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 al all hours of <br />preparation and operation Return original to festival coordinator three weeks prior to <br />this event. <br />0^ <br />( «Va <br />W«« <br />5 Gul HarxJ w<»tll <br />WMlnwutM Ccwitxnw <br />Booth must be- cr- <br />Conciete Asphalt <br />Ptywood or a I a<p <br />Garbage <br />Can <br />UfcrMh S w»’o< <br />UBorxj octtw <br />Environmenlal Health <br />l am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth <br />J. <br />I»*p <v»i Walw <br />z <br />Huh; VV»tw <br />Health Permit p <br />Names of responsible persons to be present in booth dunng all hours of operation <br />________ <br />l am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />G Three compartment sink <br />Qt-j Three deep tubs (basins 6-S 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 />S Detergent. bleach, and wiping cloths (cleaning towels) <br />S Tub to store wiping cloths in bleach solution <br />1F/68E Haze-to-'. Avenue i Stockton California 95205 | T 209 468-3420 | F 209 464-0138 ' www 5)go» or-j end <br />fHIJ’',OZ Pape «ol 11 It MP tVl N1 APP <br />ClzJL <br />S-20 Gai <br />r- Kam) Watw <br />iV <br />iob