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EnvironmentaS Health Department <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 rinseAvastewater. <br /> Paper towels and pump-style soap container. <br />'14.Completed by: <br />Paper Hand Towels <br />Cutting Board <br />Propane Stove <br />Fira extinguisher <br /> Ice Cooler <br />!• • <br /> <br />liiaBgKazg?sagaais>i <br />1 'Date <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 checkfist must be in the booth at all hours of <br />preparation and operation. Return original to festival coordinator throe wee] <br />this event. <br />Garbage <br />Can <br />Sanffizerhucket- <br />Meach & wafer tor <br />storing wiping cloths <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Stfimo wJChaffing ' <br />Dish <br />5 Gal Hand wash. <br />Wastewater Container <br />5-20 GaL <br />Hand wash Waler <br />■. Signature <br />o <br />Title <br />prior to <br />t <br />Soap aid Waler <br />13.; Names of responsible persons to be present in booth during all hours of operation: <br />• , j / y—— /a ' <br />~ <br />,■■ important** <br />E <br />Rinse VAter <br />SANJOAQUIN <br />------COUNTY------- <br />Greotncss gruws here. <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 arid tubs <br /> Other (specify). <br />'V <br />I am providing the following for adequate hand washing facilities, but separate from'.'utensil wash within my <br />booth: ' .':" <br />| Health Permit |j <br />... x -U.’ :■ . <br />I am providing fhe following items within my booth for the sanitary cleaning of.food preparation utensil <br />Three.-cbfflpfgjtment 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.taBiespoon of bleach per gallon'of water). <br /> Detergent^' bleach, and wiping cloths (cleaning towels). <br /> Tub to store wiping cloths in bleach solution. <br />lb: pSqapdispcnitf [ ---- <br />wwl <br />Bleach arid'Water <br />Exira Ice Begs & Food Containas mis! be fl <br />■siored 6 inches otf of the ground! kl <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />EHD16-02 • Page Car-Il TEMP EVENT APP <br />07/3/17 <br />Propane Tank * <br />'J 0