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Environmental Health Department , <br />10. <br />TvrTTTT <br />11. <br />OR <br />12. <br />g Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />K One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />® Paper towels and pump-style soap container. . • <br />o13. <br />KlTCHfN <br />Title Date <br />Completed by: 14. <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />1 QtcactiPropane Stove <br />I <br />Propane Tank <br />Rmso Water Btcacn and Water <br />Fire Extinguisher <br />■ Ice Cooler <br />TEMP EVENT APP <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 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 />IX Ice chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify). <br />Extra lee Bags S Food Containers must be <br />stored 6 inches ol/ ol the ground' <br />Extra <br />Waler <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Sanitizer bucket- <br />bleach & water tor <br />slonng wiping cJclhs <br />Booth must be on <br />Concrete. Asphalt, <br />Plywood, ora Tarp. <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />’ i <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 bleach per gallon of water). <br /> Detergent, bleach, and wiping cloths (cleaning towels). <br />K Tub to store wiping cloths in bleach solution. <br />i <br />Slemo wTOialfing <br />Dish <br />5-20 Cal <br />Hand wash Waler <br />Names of responsible persons to be present in booth during all hours of operation: <br />frAONtCA ________——______ <br />“Important** <br />SAN JOAQUIN <br />C '?:.'l\ • v <br />J <br />0 <br />Health Permit <br />1 <br />Soap and Waler <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.Kfe__'■''Signature <br />1868 E. Hazelton Avenue | Stockton. California 95205 I T 209 468-3420 | F 209 464-0138 | www sjgov.org/ehd <br />' n ft • a 4 Tr-kin «r“MT A f <br />EHD 16-02 Page 8 of 11 t— <br />06/19/19