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Environmental Health Department <br /> <br />w <br />ii. <br />OR <br />12. <br /> Paper towels and pymp-gtyle soap container. <br />13 Names of responsfcte persons to be present in booth during all hours of operation: <br />Completed by: 14. <br />Health Permit <br />SoapOmoHMr <br />ttMdi <br />Iit <br />PnCiarir <br />r* <br />J II <br />£ <br /> Water supply dispenser with warm water at a minimum of 100’F fi.e. 5-20 gallon container with spigot). <br /> One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />£««• lu« A AWV CwMwa C* <br />6 «|U«M Mui f* <br />Dw> <br />Title <br />•Mar «r <br />MDrmg «Orq cioma <br />I IM tM«l «MA <br />IVaifci if CatNM <br />5-20 CM <br />Hand vmM Waf <br />i <br />i <br />Gartwoe <br />Can <br />SAN JOAQUIN <br />COt.'N rv <br />Ice Cooler <br />“trnportanr* <br />lam providing the foltowing items within my booth for the sanitary cleaning of food preparation utensil <br />ST 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 />soMton (one tablespoon of bleach per gallon of water). <br /> Detergent, bleach, and wiping ctoths (cleaning towels) <br />O Tub to store wiping ctoths in bleach solution <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth <br />1 Prov*1'n9 following cold temperature control for the cold holding of potentially hazardous foods below <br />*5 F (if food is used the foltowing day matoiain below 4IT temperature): <br />Q tee chests ^Refrigerator <br />^Refrigerated truck Ice bath and tubs <br /> Other (specify)___________________________________________ <br />AH 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 at ail hours of <br />preparation and operation. Return original to festival coordinator throe weeks prior (q <br />this event <br /> zl/z/mozz. <br />Date <br />1868 E Hazelton Avenue | Stockton, California 962051 T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />EMO 1602 E«v»«UII TEMP EVENT Woanan# <br />Boom iinjat be on <br />Ccncrere. Asphalt <br />PtW>ood, or a Tarp. <br />--------- y