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Environmental Health Department <br />11. <br />OR <br />12. <br />0 Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />0 One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />0 Paper towels and pump-style soap container. <br />13. <br />14.Completed by: <br />Signature Date <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Cdttlng Board <br />BleachPropane Stove <br />n <br />Ptopane Tank <br />Blaach and Water <br />Hre Extinguisher <br />I am providing the following Items within my booth for the sanitary cleaning of food preparation utensil <br />0 Three compartment sink. <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). <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 />B Gal Hand wash <br />Wastewater Container <br />! <br />1 <br />Extra Ice Bagx A Food Containers must be <br />stared 6 inchas otfottha ground! <br />Slemo w/Chafflng <br />Diab <br />Extra <br />Waler <br />Garbage <br />Can <br />Sanitizer buoket- <br />blcachS water for <br />storing wiping dolha <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, oraTaip. <br />Q <br />Ice Cooler <br />Title <br />♦‘Important** <br />5-20 Gat. <br />Hand wadi Water <br />Names of responsible persons to be present In booth during all hours of operation: <br />[Aelan tc or Ar I ce___________________ <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 />4-T-H <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />EHD 16-02 Page 8 af 11 TEMP EVENT APP <br />4®% SAN JOAOUIN <br />------COUMTY------ <br />' Crsotnejs growi 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 />0 Ice chests E Refrigerator <br />□ Refrigerated truck E Ice bath and tubs <br />□ Other (specify) <br />Soap and Waler Rinse Water