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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />□ Paper towels and pump-style soap container. <br />13. <br />14.Completed by: <br />J <br />Paper Hand Towels <br />Cutbn.q Board <br />1Propane Stove <br />Bleach and Water <br />fl Piro Exilngjlsher <br />Ice Cooler <br />Page 8 of 11EHD 15-02 <br />07/3/17 <br />S Gel I land "rash <br />Wostovaler Container <br />5-20 Gal. <br />Hand wash Water <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach & waler for <br />storing wiping dolhs <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Stemow/Chaffing <br />Dish <br />SANJOAQUIN <br />‘ ------COUNTY------- <br />G fc u t n e. 5 y; o s h <. re. <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 416F temperature): <br />Q Ice chests ^^Refrigerator <br />□ Refrigerated truck 0 Ice bath and tubs <br />0 Other (specify)____ _____________ __________________ <br />Propane Tank <br />I,-'- ’■ - ~. ."Id,,•i,-, <br />Extra Ice Bags & Food Containers must be <br />stored 6 inches oli ol the ground! <br />lam providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />SJhree compartment sink. <br />0 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 />0 Detergent, bleach, and wiping cloths (cleaning towels). <br />0 Tub to store wiping cloths in bleach solution. <br />7 <br />Soap and Water <br />I _z <br />Rinse Waler <br />(/.ir.tn c.1 > j <br />Health Permit - <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Water supply dispenser with warm water at a minimum of 10CTF (i.e. 5-20 gallon container with spigot). <br />0 One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />| Soap dispenser j ---------, \ <br />^7 [7-U.Qt <br />1868 E. Hazelton Avenue | Stockton, California 95205 j T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />SHD 1S-02 Page 8 of 11 TEMP EVENT APP <br />Names of responsive persons to bepresent in booth^uring all hours of qperationi , < , < < i J i <br />L-i/rrrctfT z ^rxjtrxDrrl rT . , Ml rrheA* <br />‘‘Important** AU 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 />Signature Title Date <br />Extra <br />V.'ater