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s <br />Environmental Health Department <br />11. <br />OR <br />12. <br /> Paper towels ahd pump-style soap container. <br />13. <br />14.Completed by: <br />•I <br />| 1 Health Permit- [I-1 <br />Paper Hand Towete <br />Soap dispenser <br />Cutting Board <br />BleachPropane Stove <br />fl <br />Propane Tank <br />Bleach end Water <br />Fire Extinguisher <br />J <br />TEMP EVENT APRPage 8 of 11 <br />i <br />I <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 />Stemo w/Chaffing <br />Dish <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Extra <br />Water <br />6 Gal Hand wash <br />Wastewater Container <br />. ... x Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />s . ■ <br />E] p'rie separate, tub (bucket or basin) for the collection pf.rinse/wastewater. > ■ .. <br />— —1< <br />Ice Cooler g <br />______F <br />Soap and Water Rinse Water <br /> 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). i . '• <br /> Detergent, bleach, and wiping cloths (cleaning towels). <br /> Tub to store wiping cloths in bleach solution. .. <br />‘‘Important** <br />Date <br />6-20 Gal. <br />Hand wash Water <br />Extra Ice Bags & Food Containers must be n <br />stored 6 Inches off of the ground! n <br />1868 E. Hazelton Avenue | Stockton, California 95205 [ T 209 468-34201 F 209 464-0138 | www.sjcehd.com <br />EHD 16-02 Page 8 of 11 TEMP EVEN! <br />07/3/17 <br />Names of responsible persons, to be present in booth during all hours of operation: <br />C^nAi Krrr7.0Lr\i an______• • . .. ................... . ........ <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 arid operaftion. Return original to festival coordinator three weeks prior to <br />this evehtTj <br />/CsYidsw________ Dinner <br />( Title <br />^VAIWOAOUIN <br />I” < 1 ------COUNT Y------ <br />Greatness grows here. ’ ,• <br />10. lam 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): <br /> icechests □Refrigerator • <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify) _____________________ _________________