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Environmental Health Department <br />10. <br />11. <br />OR <br />1 <br />12. <br />K Paper towels and '-style soap container. <br />I <br />“Important— <br />Completed by. 14. <br />Title Date <br />Heatth Pecmft <br />QAnoeoani <br />ftapana3t*v <br />Ice Cooler <br />wa* EVENT N* <br />IfltliL1*] <br />Stamo WCMMno <br />M <br />SGUMadMb <br />Wl^i <br />S-2D QaL <br />6*» few a«pa * Foot QaiMars mat <br />CMw aTcTto graoKT <br />ni Bui >■ til <br />«ataBNpkVdae> <br /> Booth imMt bean <br /> Generate, AaptaE, <br />Plywood, are Trap. <br />--■Sr-i? <br />Gavbape <br />Can <br />E^±: <br />BtoactimdWWr <br />1868 E. Hazeton Avenue I Stockton, Cafifomia 95205 | T 209 468-3420 | F 209 464-0138 | www.sjoov.oro/ehd <br />BV*«2 P.9* 8 of 11 <br />08/2*2023 <br />P^rta—fTa»W I <br />I Hhmch <br />Mrat'WMiw <br />I am prowlinfl the Mowing items within my booth forthe sanitary cleaning of food preparation utensil <br />B Three compartment sink. <br />□ 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 />B’Detergent, bleach, and wiping cloths (cleaning towels). <br />kxTub to store wiping doths in bleach solution. <br />I am providing the following for adequate hand washing faeftties, but separate from utensil wash within my <br />booth: <br />p^Water supply dispenser with warm water at a minimum of 100‘F fi.e. 5-20 gallon container with spigaQ. <br />J^One separate tub (bucket or basin) forthe collection of rinse/wastewater. <br />awIVWter | <br />SMpdkmsOT I --------- <br />13. Names of responsible persons to be present in booth during all hours of operation: <br />D<a f(i iT/VI a a.1------------------------------------------ ------—---------------------- <br />AH food vendor booths are subject to inspection. Please make a copy of this appfication 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 /> II■ <5JV <br /><7 Signature <br />- SAN.JOA0UIN <br />------COUNTY------ <br />I am prowling the’fbLng <X temperature control for tt>e cold hoMinfl of potently hazardous foods below <br />45T (if food is used the following day, maintain below 41 F temperature). <br />^Ice chests □Refrigerator <br />□ Refrigerated truck glee bath and tubs <br />□ Other (spedfy)_—-------------------------------------------------------