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Environmental Health Department <br />w. <br />11. <br />OR for soapy water, one for rinsing and one for a bleach <br />but separate from utensil -wash within my <br />12 <br />suopty dispenser with warm water at a mmimum of 100“F (re. 5-20 gallon container with spigct). <br />13. <br />‘•important'** <br />Completed by:14 <br />Trtle <br />Health Permit <br />.^apwr Hand <br />ptopa -r to.- <br />I a Bktucn and <br />4 <br />£>>0 kn a I mu<J Im <br />*/txod 9 r^l ■>/ jj/tMnirt1 <br />t, G4> I U.H> MlUl <br />$o:>aw. Nt JCT S -uJn c- <br />sas-ng .xVn <br /> 8cc<h mist De or <br />Ccraete. AsphaK, <br /> Ftwcec, o.' j Taro <br />StBJiio v/TChotf’iia <br />Dish <br />Ice CoolerI <br />SAN IOAOUIN <br />— iCOUNTY <br />Q <br />L^Water <br />j^ One separate tub (bucket or basin) for the collection of nnse/wastewater <br /> Three deep tubs (basins 6-8 inches minimum), one <br />f^ubon (one tablespoon of bleach per gallon of water) <br />g’Deteipent. bleach, and wiping cloths (cleaning towels). <br />S^Tub to store wiping cloths in bleach solution <br />I am providing the following tor adequate hand washing facilities, <br />booth. <br />J <br />*»^|1 u.«l .V.>ta <br />I <br />R>nM> W.Ui <br />! am providing the following items within my booth for the sanitary cleaning of food preparaton utensil <br />FK Throe compartment sink <br />• ...: i ' ' ■. ■ • <br />Gaibage <br />Can <br />’ ‘ 1 <br />Temp event app <br />I -,m PiovKl.no the toBowmg cold lempemtme control to, tiro cnld hokl.nq of potentially hazardous foods below <br />45“F (if food is used the following day. maintain below 41 f temperature) <br />ice chests |.J Refogerato- <br /> Refrigerated truck I. ] Ice bath and lulls <br />0 Other (sixvrfv)_ <br />A copy of this checklist must be in the booth a*, ali hours z' <br />Return original to festival coordinator three weeks prior to <br /> <br />Date <br />I <br />b-20 Ual <br />r- Hand Ware/ <br />I Soap iliwenSCT I , , -■ \ <br />1868 E. Hazelton Avenue I Stockton, California 95206 | T 209 468 3420 | F 209 4B4-0I38 I www <br />eoMMn Puo-ajn temp event <br />C6/2&-20Z3 <br />y Paper towels and pump-styie soap container. <br />Names of responsible persons to be present in booth during all hours of operation <br /> f^yrrolii tMrxd. S ■Ot'i r\-o*- ---------------------------------------------- -------------------------- <br />All food vendor booths are subject to inspection. Please make a copy of this aPDi.catfcr. t <br />preparation for this event, <br />preparation and operation <br />this event <br />. <br />I dsina &»■/! <br />L/ Signature /