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Environmental Health Department <br />11. <br />OR <br />12. <br />13. <br />14.Completed by: <br />Paper Hand Towels <br />Soap dispenser <br />Cuttlnfl Board <br />BleachPropane Stove <br />IT IT <br />Propane Tank <br />Bleach and Waler <br />Eke Extlnpulsher <br />T: <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br /> Stemo w/Chaffmg <br />Dish <br />5-20 Gal. <br />Hand wash Water <br />Extra <br />Water <br />Sanitizer bucket­ <br />bleach & waler for <br />storing wiping cloths <br />L <br />Rinse Waler <br />_____L <br />Soap and Water <br />< / <br />Ice Cooler <br />CUJkvf <br />Title <br />Extra /co Sags 4 Food Containers must ba M <br />stared 6 Inches otTot the ground! M <br />**lmportant** <br />iV I- J <br />■ <br />10. <br />Signature <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />J^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 />^Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />£2£one separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Paper towels and pump-style soap container. <br />Names of responsible persons to be present In booth during all hours of operation: <br />^SANJOAQUIN <br />------COUNTY------- <br />.■'v Creoi ne.r.s grow;, hare. <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 />3jce chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify) <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16-02 Page 8 of 11 TEMP EVENT APP <br />06/19/19 <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 />preparati^jq and operation. Return original to festival coordinator three weeks prior to <br />this eve.