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Environmental Health Department <br />11. <br />OR <br />12. <br />O 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 />0 Paper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation: 13. <br />Completed by: 14. <br />DateTitleSignature <br />Paper Hand Towels <br />Soap dispenser <br />Propane Stove <br />A J <br />Propane Tank <br />Bleach and WaterRinse WaterSoap and Water <br />Fire Extinguisherfl <br />TEMP EVENT APR <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <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 />0 Detergent, bleach, and wiping cloths (cleaning towels). <br />0 Tub to store wiping cloths in bleach solution. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Sterno 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 />Extra Ice Bags & Food Containers must be <br />stored 6 inches off of the ground! <br />5-20 Gal. <br />Hand wash Water <br />SANjJOAQUIN <br />------COUNTY—- <br />( .-.-Y| <br />Ice Cooler........v <br />Greatness grows 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 />0 Ice chests 0 Refrigerator <br />0 Refrigerated truck 0 Ice bath and tubs <br />0 Other (specify) __________ <br />Health Permit <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 />**lmportant** <br />1868 E. Hazelton Avenue I Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />1 r-. r - -l”l—p *l-' I—A /I—K ■“!EHD 16-02 PageSofl! ■■— —— <br />07/3/17 <br />-QIflu z - <br />10. <br />Cutting Board <br />Bleach