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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 /> One separate tub (bucket or basin) for the collection of rinse/wastewater. <br /> Paper towels and pump-style soap container. <br />13. <br />**lmportant** <br />Completed by:14. <br />I <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />BleachPropane Stove <br />Propane Tank <br />Rinse Water Bleach and Water <br />Fire Extinguishera <br />__Zl <br />Soap and Water <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 /> Tub to store wiping cloths in bleach solution. <br />Names of responsible persons to be present in booth during all hours of operation: <br />RAYFORD HUDSON IV <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 />KJ Other (specify) BUILT IN AT FACILITY <br />Stemo w/Chaffing <br />Dish <br />Extra <br />Water <br />5 Gal Hand wash <br />Wastewater Container <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 />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: BUILT IN AT FACILITY <br />5-20 Gal <br />Hand wash Water <br />SAN JOAQUIN <br />------COUNTY— <br />Greatness qrOwi here. <br />Verified by PDFfiller I <br />PROMOTER <br />Title <br />Extra Ice Bags & Food Containers must be I <br />stored 6 inches off of the ground1 j <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. [ verified by PDFfiller I y <br />PZTOD V-X___ -- j promoter <br />Signature Title Date <br />Ice Cooler <br />[ Health Permit <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 />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />KI Three compartment sink. BUILT IN AT FACILITY