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Environmental Health Department <br />10. <br />11. <br />OR <br />s< <br />12. <br />13. <br /> I <br />•"Important** <br />5T14.Completed by: <br />Signature Date <br />Pnper Hand Towels <br />Culllnft Board <br />Propane stove <br />t <br /> <br />IWl <br />Bleach and Water <br />Ice Cooler <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />fhree deep tubs (basins 6-8 Inches minimum), one for soapy water, one for rinsing and one for a bleach <br />ition (one tablespoon of bleach per gallon of water). <br />Detergent, bleach, and wiping cloths (cleaning towels). <br />fub to store wiping cloths in bleach solution. <br />Exira lea Bags 4 Food Containers must be <br />stored 6 Inches offol the ground/ <br />Exira <br />Wafer <br />5 Gal Hond wash <br />Was la water Contain er <br />Garbage <br />Can <br />SanlUzsr bucket­ <br />bleach & waler for <br />otonng wiping cloths <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Stamo w/Chaffioo <br />Dish <br />SAN JOAQUIN <br />■-----COUMTY------- <br />Title <br />Bleach <br />— <br />Soap and Waler <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16-02 Pane 8 of 11 TEMP EVENT APP <br />08/19/10 <br /> <br />Piopane Tank <br />_____________1 <br />5-20 Got <br />r- Hand wash Water <br />f MJiL <br />Irhetus of operation: <br />Rinse Water <br />J^Water supply dispenser with warm water at a minimum of 100°F (l.e. 5-20 gallon container with spigot). <br />^One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />J^.Paper towels and pump-style soap container. <br />Names of responsible persons to be presentjn booth during alt< <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): \ / A <br /> Ice chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify) <br />| Health Permit <br />| Sobo dispanaor | <br />All food vendor booths are subject tolnspectlon. Please make a copy of this application In <br />preparation for this evenKA copy'ohthis checklist must be In the booth at all hours of <br />preparation apd^pperatlpSn. Return prifrinal to festival coordinator three weeks prior to <br />this evei