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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 />**lmportant** <br />14.Completed by: <br />Title <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />Propane Stove Bleach <br />0y <br />Rinse Water Bleach and Water <br />Fire Extinguisher <br />EHD 16-02 <br />07/3/17 <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 rinse/wastewater. <br />Sterno v./Chaffir.g <br />Dish <br />5 Gal Hand wash <br />Wastev^ter Container <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />Booth must be on <br />Concrete, Asphalt <br />Plywood, or a Tarp <br />Extra <br />Water <br />5-20 Gal. <br />Hand wash Water <br />SANJOAQUIN <br />- COUNTY <br />_z <br />Soap and Water <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 and tubs <br /> Other (specify)^ <br />O 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 />p3jub to store wiping cloths in bleach solution. <br />I op1 providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />|3Jhree compartment sink. <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 an^operation/ffieturn original to festival coordinator three weeks prior to <br />thisjeyent.^// //^ “ / <br /> <br />[/ Signature Title Date <br />—------------•( <br />Ice Cooler j <br />Extra tee Bags & Food Containers must be I •] <br />stored 6 inches off of the ground' f j <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />•5 -2 Page 8 of 11 TEMP EVENT APP <br />Health Permit U <br />Names of responsible,persons to be present in booth during all hours of operation: <br />FeJi* _________________ <br />Prepane Tank <br />2