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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />50 Paper towels and pump-style soap container. <br />13. <br />‘‘Important** <br />14.Completed by: <br />Paper Hand Towels <br /> Soap dispenser <br />Culling Board <br />/BleachPropane Stove <br />0 <br />Propane Tank <br />Bleach and Water <br />Fire Fxtinnuishor <br />Ice Cooler <br />Ultra Ice Bags S Food Contninors must bv <br />stored 6 inches otto!tho ground! <br />Extra <br />Waler <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 />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 />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 />EJ Ice chests 0 Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify)_ <br />Slorno w/Ghatring <br />Dish <br />5 Cal I land wash <br />Wastowator Container <br />SAN JOAQUIN <br />C OU N ■ '' <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 />this event. > <br />Fo- <br />Title <br />___L <br />Soap and Wator Hinso Wator <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />® Three compartment sink. <br />5-20 Gal. <br />y I land wash Water <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 />Namesof responsible persons to be present in booth during all hours of operation: <br />| ifygxvHO VVXA A J 7- ul - 50? Y <br />1868 E. Hazelton Avenue | Stockton. California 95205 I T 209 468-3420 1 F 209464-0138 | www.sjqov.orq/ehd <br />paqo 8 of 11 TEMP event appUt)/ C.'jl <1^4*0 <br />Signature <br />Health Permit