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? <br />Environmental Health Department <br />i'. <br />10. <br />11. <br />OR <br />12. <br /> 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 />TQ Paper towels and pump-style soap container. <br />13. <br />‘•Important** <br />Completed by:14. <br />Health Permit <br />Paper Hard Towels <br />Propane Sieve <br />Pirn Extlnflulshor <br />Ice Cooler <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />Film Icn Rays A Food Containers most be <br />stored 6 inches oil ol the ground’ <br />5 Gal Hand wash <br />Waitewaiar Container <br />5-20 Gal. <br />Hand wash Water <br />Garbage <br />Can <br />Booth must be on <br />Concrete. Asphalt, <br />Plywood, or a Tarp. <br />Stamo vi/Chaffing <br />Dish <br />( Extra \ <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 />this eve jt. ; |x AhIa/; ,r\ . <br />Propane Tank <br />md ope^tion. Return original to festival coordinator three weeks prior to <br />RL bKNinc i <br />Title Date <br />Names of responsible persons to be present in booth during all hours of operation: <br />_________Q i nk/ki i rl___________ <br />_z <br />Soap and Water <br />la <br />Rinse 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 />0773/17 <br />SAN JOAQUIN <br />------COUNTY------- <br />i(|| ,.i.f Cn eo»nt ->s q. ov.S hert. <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 />:ion and <br />Signature <br />'KJ 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 />| Soap dispenser j ---------- <br />Bleach <br />Sanrtoar bucket­ <br />bleach & water for <br />tlortng wiping cloths <br />I Cutting Board |