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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br /> Paper towels and pump-stvle soap container. <br />13. <br />•‘Important** <br />14. <br />Paper Hana Towels <br />Cutting Board <br />Propane Stove <br />u <br />PnopanaTank <br />Btosch and Water <br />Pre EximryjisnerQ <br />Ice Cooler <br />r-------- —- <br />Health Permit <br />r~~~----- ---------------- <br />Extra ice Bags S Fcca Containers must be <br />stored S inches at c! the ground! <br />S Gel! land •.«ash <br />'.varzwatar Centatnor <br />Garbage <br />Can <br />Booth must be on <br />Concrete. Asphalt. <br />Plywood, or a Tarp. <br />Stemo w/Cha!fing <br />Dish <br />5-20 Gal. <br />Hand wash Water <br />Sanitizer bucket- <br />blcach a waler for <br />storing wiping cloths <br />T) providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />.Three compartment sink. <br />SAN JOAQUIN <br />------COUNTY------- <br />• tl f .'li . j Jii s Illi.. <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />45OF (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 />I L <br />Soap and Water <br />7 <br />Rinse Water <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />l^A/ater 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 />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 1 F 209 464-0138 I www.sjcehd.com <br />otSit’02 Pa9e 8 of 11 TEMP APP <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 />| Soap dispenser | ------- <br />3IJ0M <br />Names of responsible persons to bepresent in boothduring all hours of operation; ,« ■ . i > I . <br />U-Trffifl Ca\ in . naLf|rtiQ <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 operatioiy Return original to festival coordinator three weeks prior to <br />Completed ___________OSjOblZ <br />’ ‘'"'Signature Title Date <br />Eilra <br />Water