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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br /> Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />0 One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />0 Paper towels and pump-style soap container. <br />13.Names of responsible persons t< <br />14.Completed by: <br />Paper Hand Towels <br />Soap dispenser <br />BleachPropane Stove <br />n <br />Propane Tank <br />Bleach and Water <br />Fire Extnguishor <br />Ice Cooler 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 />Booth must be on <br />Concrete. Asphalt. <br />Plywood, or a Tarp. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Garbage <br />Can <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 />0 Other (specify) <br />Slemow.'Chaffing <br />Dish <br />SAN JOAOUIN <br />-- COUNT Y <br />,1 <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 anb operation. <br />this event, f Y <br />Signature <br />c_L <br />Soap and Waler <br />i <br />A <br />’’Important** <br />_z <br />Rins# Water <br />id operation. Return original to festival coordinator three weeks prior to <br />:ninjas <br />Title Date <br />I Cutting Board <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 bteactuper-gallon of water). <br />'S Detergent, bleach, and-wrpirig'ciotlisT^eaning towels). <br /> Tub to store wiping cloths in bleach solution. <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />0 Three compartment sink. <br />Extra Ice Bags 8 Food Containers mus! be <br />stored 6 Mias odotlhe groundl <br />- --------------------------------' —'T <br />Health Pormit p <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 TEMP EVENT APP <br />07/3/17 <br />onsible persons to-be present in booth during all hours of operation: <br />Extra <br />V.’Qlcr