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Environmental Health Department <br />10. <br />11. <br />OR <br />12 <br />M 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 towels and pump-style soap container. <br />13. <br />Important** <br />14.Completed <br />Signature <br />Health Permit <br />Paper Hand I CAdS <br />Cvtbng Board <br />Propane Sieve <br />Propane Tank <br />ftieacn and Waler <br />Teo Filrngusner <br />Ice Cooler <br />TEMP EVENT APP <br />r <br />tatra <br />Water <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 items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <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 4TF temperature) <br />[XI Ice chests [ I Refrigerator <br /> Refrigerated truck Ice bath and tubs <br />El Other (specify)_ __________________________ <br />I it'd Ice Ragi S f ooO Conldmen rruit be <br />Moicd C niches oh ol the giouml' <br />5 Ga' Handwash <br />Waslcwalcr Conimncr <br />Garbage <br />Can <br />Sa-Wizcr b.ickci <br />Meac/i A water for <br />srp-.-g wipng cloths <br />Booth must be on <br />Concrete. Asphalt <br />Plywood, or a Tarp <br />1868 I <br />EHD 16-0? <br />06’19/19 <br />_Jx| 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 />J^Tub to store wiping cloths in bleach solution. <br />Stcrno wrChafting <br />Dish <br />S-20 Gai <br />Hand wash Waler <br />SAN JOAQUIN <br />- • I. ■ <br />V-/o- zy <br />DateTitle <br />Rinse Water <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 even: <br />I lazclton Avenue | Stockton (California 95205 | T 209 468 3420 | F 209 464-0138 | www sjgov ory/ehd <br />Page 8 ol 11 TCM? CVEM’ .*.! <br />Soap dispenser------------ <br />| <br />3LJoz <br />Soap and Water <br />Names of responsible persons to be present in booth during all hours of operation: