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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />IX) Water supply dispenser wiin warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />[XOne separate tub (bucket or basin) for the collection of rinse/wastewater. <br />IX) Paper towels and pump-style soap container. <br />13. <br />“Important** <br />14.Completed by: <br />Papo< Hand Towels <br />BloachPropane Stove <br />Prooano T ank <br />Bleach and WaterRinse WaterSoap and Waler <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />□ Three compartment sink. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Storno w/Chattlng <br />Dish <br />E«tra <br />Water <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach 4 water for <br />storing wiping cloths <br />Booth must be on <br />Concrete. Asphalt, <br />Plywood, or a Tarp <br />Ice Cooler <br />___________/ <br />SANJOAOUIN <br />------COUNTY------- <br />G''eotnes$ qro^s 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. maintain below 41 °F temperature): <br />Ice chests O Refrigerator <br />□ Refrigerated truck O Ice bath and tubs <br />□ Other (specify) <br />Owner <br />Title <br />KI 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 />S Detergent, bleach, and wiping cloths (cleaning towels). <br />0 Tub to store wiping cloths in bleach solution. <br />OeiCO/SOgB <br />Date <br />Ettra lea Bags 4 Food Conlama't must be B <br />sKxed 6 inches oHo! tha ground' i’l> <br />I Cutting Board <br />Names of responsible persons to be present in booth during all hours of operation: <br />Stephanie Jackson <br />All food vendor booths are subject to inspection. Please make a copy of this application in <br />preparation for this eveoL A copy of this checklist must be in the booth at all hours of <br />preparation and operatidrAReturn original to festival cc onjlnator three weeks prior to <br />’ |SlgnatureF <br />5-20 Gaf <br />r- Hand wanh Water <br />I Soap dispenser I ---------- \ <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16-02 Pago 8 oM 1 TEMP EVENT APP <br />06/19/19 <br />| Health Permit |-