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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 towete and >styte soap container. <br />13. <br />"Importanf <br />81M <br />Date? <br />Completed by: 14. <br />Sig nature <br />Health Permit <br />Paper Hand Towels <br />Soap dbpenier <br />Dloech <br />Ice Cooler <br />PaQe S of 11 <br />iOiii? <br />ru. b^j» 4 Acxxl (XMJIMM* <M1 <br />ttuva t <Jt ui Vi« <br />SamiaOaMr^ CM <br />6 GJ lUnd w«W> <br />W«lrwl»( ContarMf <br />Booth must be on <br /> Concrete; Asphalt, <br />Plywood, or a Tarp. <br />I am providing the folowing for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Sanitizer bucket­ <br />bleach & waler for <br />storing wiping cloths <br />I am providing the folknvfog cokl temperature control for Iho cold holding of potentially hazardous foods below <br />45T (if food is used the folfowing day. maintain below 41*F temperature): <br />O toe chests Q Refogerator <br /> Refrigerated truck Ice bath and tuba <br /> Other (Specify _________________________________________________ <br />Garbage <br />Can <br />SAN-JOAQUIN <br />C OUNB <br />5-20 Gal. <br />Hand wash Wator <br />\ <br />Blaach and WaW <br />Al 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 />I <br />I QAX. bowrt <br /> Three deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for a bleach <br />solution (one tabtespoon of bteach per gallon of water). <br /> Detergent, bleach, and wiping cloths (cleaning towels). <br /> Tub to store wiping ctoths in bleach solution. <br />Names of responstte persons to be present in booth during all hours of operation: <br />I am prwidinp the faitowing Items within my booth for the sanitary cleaning of food preparation utensil <br />O Three compertmerrt sink. <br />I Propana Irt <br />/)i0ner~ <br />Title <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16-02 Pa^eBolll TEMP EVENT APP <br />06/i ang <br />F»» EjU>vu<alM I <br />E-d/a <br />Waior