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Environmental Health Department <br />11. <br />OR <br />12. <br />13. <br />Completed by: 14. <br />Title <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Ecard <br />BleachPropane Stove <br />if <br />Rinse Water <br />Fife Extinguisher <br />Ice Cooler ' <br />TEMP EVENTAPP <br /> One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />0z^aper towels and pump-style soap container. <br />Extra tea Bags & Food Containers must be <br />stored 6 inches off of the ground! <br />5 Gal Hand wash <br />Waste-water Container <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach 8 water for <br />storing v/iping cloths <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />5-20 Gal. <br />Hand wash Water <br />Stemo w/Chaffing <br />Dish <br />Health Permit <br />^te^ <br />iT Jw-T „ <br />Bleach and Water ! <br />10. <br />SANJOAOUIN <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 following day^jnaintain below 41 °F temperature): <br /> Ice chests [^Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify) <br />Propane Tank J <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 />EETbetergent, bleach, and wiping cloths (cleaning towels). <br />ETfub to store wiping cloths in bleach solution. <br />Ian>providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />0Three compartment sink. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />b00th: <4 S' // <br />(^fWater supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />EHD 16-02 Page 8 of 11 TZM.” Z’.'Zf <br />07/3/17 <br />Soap and Water <br />Names of responsible persons to be present in booth during all hours of operation: <br />/tz / i-LrA-W'^__________________________________________________________ <br />vLA A /U / i-f-i ________________________________________ <br />**lmportant** 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 />this event, t /)/) <br /> <br />Signature <br />Extra <br />V/ater