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A': <br />Environmental Health Department <br />10. <br />11. <br />OR for rinsing and one for a bleach <br />12. <br />Nam'13. <br />Important** <br />Completed by:14. <br />Paper Hana Towels <br />1Rinse waterSoap and Water <br />Fire Extinpuisher <br />Extra Ice Bags & Food Containers must be n <br />stored 6 inches off of the ground! J <br />Extra <br />Water <br />5 Gal Hand wash <br />Wastewater Container <br />Sanitizer becket- <br />t'cap” 4 wa-o-’:- <br />stenrg wiping doths <br />Booth must be on <br />Concrete. Asphalt, <br />Plywood, or a Tarp. <br />5-20 Gal. <br />Hand wash Water <br />SAN JOAQUIN <br />- -COUNT / <br />: [ Ice Cooler- <br />sanitary cleaning of food preparation utensil <br />I am providing the following cold temperature control for the cold holding of polonlially hazardous foods below <br />45°F (if food is used the following day. maintain below 41 I- tomporaluro). <br />0 Ice chests ® Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify)—----------- ------— <br />b.,;; <br />, ?gHD 16-02 <br />•07/^7.. <br />H Paper towels and pump-style soap container. <br />.‘‘-.meshof responsible persons to be present in booth during all hours of operation. <br /> <br /> <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 or <br />preparation anc . <br />this event/y /I . <br />Sign'ettfre <br />lam providing the following items within my booth for the <br />0 Three compartment sink. <br /> Three deep tubs (basins 6-8 inches minimum), one for soapy water, one <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 />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />0 Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />H One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />d operation. Return original to festival coordinator three weeks prior to <br />Title Date <br />Bioach and Water I I Garbage <br />------------------| I Can <br />^flp riazfilton Avenue I Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com1 wo t. nazeuui i mvchu , &1 TEMp App <br />Soap dispenser <br />0'each <br />Propane Stove <br />Slerno w/Chaffing <br />Dish