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Envlrofumeh^aB Heaflth Department( <br />TO-. <br />11. <br />OR <br />12. <br /> Wafer supply dispenser with warm wafer at a minimum of 166°F (i.e. 5-20 gallon container with spigot). <br /> One separate tub (bucket or basin) for the collection of rinse/wastewater. <br /> Paper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation:13. <br />■“Important^* <br />14.Completed by: <br />Paper Hand Towels <br />Soapand Water Sleachand Water <br />Ffre Extinguisher <br />L J <br />! <br />TEMP EVENT APP <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within rriy <br />booth: <br />Sterna w/Cbaffing <br />Dish <br />EHD 16-02' <br />07/S/17 <br /> Booth must be on <br />Concrete, Asphalt, <br />Plywood, ora Tarp. <br />5-20 Ga!. <br />Hand v/ash Water <br />Garbage <br />Can <br />Ice Cooler <br />:________Z <br />Rinse Water <br />I Extra ' <br />I Wal er <br />iSleac'i <br />I Propane Tanlc <br />Cutting ’Soard <br />Propane Stove , <br />Health Peirnif <br />Sanitizer bucket- <br />blesch S. water Ter <br />slodng wiping cloths <br />I am providing the following items within my booth for the sanitary cleaning of foed preparation utensil <br /> Three compartment sink. <br />SAIWAOUIN <br />------COUNTY-------’ <br />Greotness grows 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-folfowing day, maintain below 4T°F temperature): <br /> Ice chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify)., ________;_____________________ <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 gall.bn of water). <br /> Detergent, bleach, and wiping cloths (cleaning towels). <br /> Tub to store wiping cloths in bleach solution. <br />All food vendor booths are subject to inspection, Pleas.e 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 /> <br />Title Date Y <br />Sira .'ca Bags &.Food Conlslnars rwsCie <br />slorad 6 Inches ctfrifthe grwndl <br />| Soap dispenser J -------- <br />Signature <br />1868 E. Hazelton Avenue | Stockton, California 95205 | 7 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />Page 8 0(11 ’ ’ vh.TmU.T <br />5 Gel Hand wash. L <br />Wasfewaler Contain er <br />14