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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />13.Names of responsible persons to be present in booth during all hours of operation: <br />Title ' <br />14.Completed by: <br />Paper Hana Towels <br />Scop oispcnscr <br />Cuttinq Bca.tJ <br />BleacliPropane Stove <br />Lll <br />Propa.no Tank <br />Rinse Water Bleach and Water <br />Ice Cooler 1 <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 />5 Gat Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Sanitizer tiuckel- <br />bleach & water 'or <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: <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 jS^Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify)__________________________________________________________________ <br />Extra leo Sops S Fcsd Containers must t>c <br />stared 6 inches oft of the ground! <br />Stcrno w/Chatfing <br />Dish <br />S-20 Gal <br />Hana wash Water <br />SAN JOAQUIN <br />-----COU NTY------- <br />— <br />Soap ana Waler <br />I (----IL <br />Health Permit J <br />Paper towels and pump-style soap container. <br />Date <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 ev^rtT^^ <br />Signature <br />lam providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />P^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 /> Detergent, bleach, and wiping cloths (cleaning towels). <br /> Tub to store wiping cloths in bleach solution. <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 />Fire Extnouishcr | <br />"Important**