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SANJOAQUIN Environmental Health Department <br />11. <br />OR <br />12. <br />B Water supply dispenser with warm water at a mtalmum of 100T (i.e. 5-20 gallon containe r with spigot). <br />0 One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />H Paper towels and pump-style soap container. <br />13. <br />**lmportant** <br />iks prior to <br />14.Completed by: <br />Health Permit <br />i <br />Paper Hand Towels <br />Soap dlaparwer <br />Cutting Board <br />BleachPropane Stove <br />Propane Tank <br />Soap and Water Rinse Water Bleach and Water I <br />Fire ExOngutahef <br />TEMP EVENT APPEHD 16-02 <br />07/3/17 <br />Stemo w/Chaffing <br />1 DUh <br />S Gal Hand wash <br />Wastewater Container <br />Ga bage <br />Gan <br />Sanitizer bucket- <br />bleadift water for <br />storing wiping dolhs <br /> Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />I <br />I <br />i <br />i <br />i <br />i <br />Ice Cooler M <br />________Z <br />RK <br />and operation. Return oriqlnal to festival coordir. <br />' Signature Title <br />5-20 Gal. <br />Hand wash Water <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartmerit sink. <br /> Three deep tubs (basins 6-8 inches minimum), one for si <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 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 /> Ice chests Refrigerator <br /> Refrigerated truck . J Ice bath and tubs <br />Other (specify)__j. <br />Names oyesponslble Gersons to be present in booth during all hours of operation: <br />//cb ry _________ _______________________ <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 t!M‘ ffy/h <br />' Signature fl Title 'Cafe <br />Extra fc« ^ags & Food Containers must be <br />stored 8 inchet off of the ground! <br />soapy water, one for rinsing and one for a bleach <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />SAN JOAQUIN <br />----COUNTY----- <br />Greatness grows here. <br />10, <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />Pege 8 of 11 ---------------------