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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />13. <br />“Important** <br />14.Completed by: <br /> Paper Hand Ttnvels <br />Prepane Stove <br />fl <br />■) <br />Bleach and Water <br />Fire ExtinguisherQ <br />Ice Cooler <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 rinsing and one for a bleach <br />solution (one tablespoon of bleach per gallon of water). <br /> Detergent, bleach, and wiping cloths (cleaning towels). <br /> Tub to store wiping cloths in bleach solution. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Ex.'ra l:e Bags & Foori Cordainers must be <br />sto-td e inches off of the ground! <br />Ertra <br />Water <br />Garbage <br />Can <br />Booth must be on <br />Concrete. Asphalt. <br />Plywood, ora Tarp. <br />Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />JTfbne separate tub (bucket or basin) for the collection of rinse/wastewater. <br />ETPaper towels and pump-style soap container. <br />5 Gal Hand wash <br />Was'.ewate' Container <br />5-20 Gal. <br />Hand wash Water <br />Sanitizer bucket­ <br />bleach 1 water tar <br />storing vaping cloths <br />Slemo w/Chaffmg <br />Dish <br />SAN JOAQUIN <br />------COUNTY------- <br />...... GrCt71ne . •> vs 'net <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 Ice bath and tubs <br /> Other (specify) <br />Propane Tank <br />Title <br />£ <br />Date <br />IT <br />Rinse Waler <br />Names of responsible persons to be present in booth during all hours of operation: <br />ipww Ntrn <br />I I <br />Health Permit U <br />’CL <br />Soap and Water <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />EHD 16-02 Page 8 of 11 TEMP EVENT APP <br />07/3/17 <br />Soap dispenser ---------- - <br />300 <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 operatioji. Returryorfairial to festival coordinator three weeks prior to <br />Signature