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Environmental Health Department <br />) <br />11. <br />OR <br />12. <br />'aper towels and pump-style soap container. <br />13.Names of responsible persons to be present In booth during all hours of operation: <br />() <br />Completed by:14. <br />Paper Hand Towols <br />Soap dlipanier <br />Cutting Board <br />BleachPropane Stove <br />• ”wPropane Tank <br />Rinse Water Bleach and Water <br />Fire Extrnpulsher <br />Ice Cooler <br />Stemo wfChaffing <br />Dish <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 />45^ <br />5-20 Gal. <br />Hand wash Waler <br />Sanitizer bucket­ <br />bleach & water tor <br />storing wiping cloths <br />Extra <br />Weter <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 />C It l&S-___ <br />v Signature <br />I anvfxovlding the following Items within my booth for the sanitary cleaning of food preparation utensil <br />□'Thpse compartment sink. <br />SANJOAOUIN <br />! ------COUNTY------- <br />Greetness growj he-e. <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />f food is used the following day, maintain below 41 °F temperature): <br />lests Refrigerator <br />□Refrigerated truck Ice bath and tubs <br /> Other (specify) <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />boott);' <br /> Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />□TOne separate tub (bucket or basin) for the collection of rinse/wastewater. <br />□J Ttyee (ieep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for a bleach <br />solptlop-fbne tablespoon of bleach per gallon of water). <br />□fp^tergent, bleach, and wiping cloths (cleaning towels). <br />Ed Tub to store wiping cloths in bleach solution. <br />Soap and Water <br />**lmportant** <br />| Health Permit <br />■ T. ' ?•> <br />(fj <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 PageBofll TEMP EVENT APR <br />06/19/19 <br />Exira I co Bags 4 Food Containers must be l| <br />stored 6 Inches otf of the ground! ■ <br />10.