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Environmental Health Department <br />10. <br />Nf A <br />11. <br />OR <br />one for rinsing and one for a bleach <br />utensil wash within my <br />13. <br />14.Completed by: <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />Propane Stove <br />Bleach <br />Propane Tank <br />.^7 Rinse Water Bleach and Water <br />Fire Extinguisher <br />Page 8 of 11 <br />It <br />Health Permit h <br />Garbage <br />Can <br />Booth must be on <br />Concrete, Asphalt <br />Plywood, or a Tarp <br />Sterno w/Chaffing <br />Dish <br />5 Gal Hand wash <br />Wastewater Container <br />5-20 Gal <br />Hand wash Water <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />SAN JOAQUIN <br />COUNTY <br />__1 <br />Soap and Water <br />Na^e|'Ufe-U°nS'kVcLt°nS t0 be present 'n b00th dUrin9 a"h0UrS of operation: <br />| Ice Cooler j i <br />“Important** <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 />O Ice chests Refrigerator <br />Q Refrigerated truck O Ice bath and tubs <br />^^QOther (specify). <br />All food vendor booths are subject to inspection. r:~ <br />preparation for this event. A copy of this checklist <br />lam providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. kj A <br /> Three deep tubs (basins 6-8 inches minimum), one for soapy water, <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 />Please make a copy of this application in <br />-----S-Hii <br />s‘9nature 5-^ ----- <br />I am providing the following for adequate hand washing facilities, but separate from <br />booth: <br /> Water supply dispenser with warm water at a minimum of 1 GOT (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 />Extra Ice Bags & Food Containers must be <br />Stored 6 inches off of the ground! <br />HaZelton Avenue I Stockton, California 95205 | T 209 468-3420 I <br />08/18/18 Pace 8 nf 11 F 209464-0138 | www.sjgov.org/ehd