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Environmental Health Department <br />10 <br />11 <br />OR <br />12. <br />Paper towels and pump-style soap container <br />13 <br />Important** <br />Completed by:14. <br />JHealth Permit <br />Pl per Hynd Tows <br />Bleacfi <br />Piopanc Slow <br />OJ <br />Propane Tank <br />Bleach and Waler <br />Ice Cooler <br />TFMPEVENT ATPPage a ot 11 <br />Extra tea flog., « Food Cooumo'3 must bo <br />noied 0 mcbai ott ol the growxf <br />Stemo w/Chatfmo <br />Dlah <br />fiGallluriU «ath <br />Wonurerolcr Conlumor <br />Booth must be on <br />Concrete. Asphalt <br />Plywood, or a Tarp <br />SANJOAQUIN <br />COU NT't - <br />5 20 Gm <br />Hand wash Waler <br />Garbage <br />Can <br />Sgmtwer buclret- <br />Oleach 3 waler la <br />itonog raping doth! <br />rw <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°F (i.e 5-20 gallon container with spigot). <br />Kfl One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Title <br />All food vendor booths are <br />preparation for this event <br />preparation an/Tbperation <br />Signature <br />1868 E. Hazelton Avenue | Stockton. Cahfomia 95205 | 1,209 468-3420 | F 209 464 0138 | www sigowo^ehd <br />06/I0H9 <br />Fire ErtinouHher <br />V <br />Rinse Water <br />Soap dispenser <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />□ Three compartment sink. <br />Three deep tubs (basins 6-8 inches minimum), one for soapy water, one for nnsing and one for a bleach <br />JgJulion (one tablespoon of bleach per gallon of water) <br />J^Detergent. bleach, and wiping cloths (cleaning towels). <br />Njub to store wiping cloths in bleach solution <br />-tibject to inspection. Please make a copy of this application in <br />A copy of this checklist must be in the booth at all hours of <br />Return original to festival coordinator three woeks prior to <br /> gjisUu? <br />Date <br />qro,-. \ .‘lerj <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 />[^Ice chests ^.Refrigerator <br />□ Refrigerated truck Q ice balh and tubs <br />□ Other (specify)______________________________________ ________ <br />Names of responsible persons to be present in booth dunng all hours of operation: <br /> <br />Soup and Watei <br />E«uo <br />Wot»>