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Environmental Health Department <br />w. <br />11. <br />OR <br />12. <br />l^Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />[^pne separate tub (bucket or basin) for the collection of rinse/wastewater. <br />t^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 />Completed by:14. <br />Signature <br />Paper Hand Towels <br />Cutting Board <br />BieachPropane Stove <br />Propane Tank <br />]Fire Extinfluiner(3 <br />Ice Cooler <br />TEMP EVENT APPPage 8 of 11 <br />Extra <br />Water <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />5 Gal Hand <br />Wastewater Container <br />5-20 Gat. <br />Hand wash Water <br />Garbage <br />Can <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />SAN JOAQUIN <br />------COUNTY------ <br />Stemo wtCtiaffing <br />Dish <br />Sanitizer buckot- <br />bleach i water rar <br />storing wijirg doths <br />Scap and Water <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />45T (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 />__________-saasE <br />| Health Permit <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 />Title Date <br />Jg 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 />j Sono dispenser | <br />1868 E. Hazelton Avenue I Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />EHD 16-02 ^se 8 of 11 TEMP EVENT <br />07/3/17 <br />—n i:Bleach and Water 8 j;------LiRinse Water <br />Extra /ct? Bojr 4 Feed Contadors txr <br />stored 5 inches alf of the grcurxl!