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Environmentail Health Department. <br />10. <br />11. <br />OR <br />12. <br />S Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br /> One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Q Paper towels and pump-style soap container. <br />13. <br />‘’Important4* <br />Completed by: 14. <br />Health Permit <br /> Paper Hand Towels <br />Cutung Soard <br />S'eacnPropane Srove <br />n <br />Propane Tank <br />Bleach and V.'aier <br />Frt ExtinguisherQ <br />Ice Cooler <br />Page 8 of 11EHO 16-02 <br />07/3/17 <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 />Q Detergent, bleach, and wiping cloths (cleaning towels). <br />Tub to store wiping cloths in bleach solution. <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Garbage <br />Can <br />Sanitizer buckel- <br />blesch i water ter <br />storing sviping doths <br />BootTi must be on <br />Concrete, Asphalt. <br />Plywood, or a Tarp. <br />Stsmc w/Chatfng <br />Dish <br />Extra <br />Water <br />5-20 Gal <br />Hand wash ’.Vale- <br />SAN JOAQUIN <br />-----COUNT Y------- <br />5 Gal Hand wash <br />'Wastewater CenUncr <br />' Signature <br />- ---- -------- - <br />Extra ice Bags S Fosd Containers must be <br />stored 6 inches of of the grcvrsP <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 bath and tubs <br />^0 Other (specify)_______________________________________________ <br />rT4 LZ T <br />Soap and Water Rinse Waler <br />Names of responsible persons to be present in booth during al! hours of operation: <br />________________ <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 I F 209 464-0138 | www.sicehd.com <br />cun « nn -------------- .. TEMP EVENT APP <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 at all hours of <br />preparation and operation. Return original to festival coordinator three weeks prior to <br />Title <br />Scap dispenser _ <br />bl