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O'fPiJpd uiJDdOE%3dl/x8EAguMaj9AKjfe/5/wo3 XDqdojpMMM//.sdui| <br />) <br />Environmental Health Department <br />11. <br />OR <br />5 <br />12. <br />i <br />H Water supply dispenser with warm water at a minimum of 1 DOT (l.e. 5-20 gallon container with spigot). <br />E One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />E Paper towels and pump-style soap container. <br />13. <br />"Important"* <br />14.Completed by: <br />Health Permit <br />Paper Hand Towale <br />IPropans Slovo <br />Soap and Water Btoach and Water <br />Rre Extinguishera I <br />Stetno w/Chaftlng <br />Dish <br />5-20 Gel. <br />Hand wash Water <br />I JO I abt'd <br />wd ar.R 'ei/s/v <br />Garbage <br /> Can <br /> Booth must ba on <br />Concrete, Asphalt, <br />Plywood, or a Tarp- <br />f <br />I <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />0 Gal Hand wash <br />Westowaler Container <br />SanMzerbuckat- <br />bleach & water for <br />storino wring dota <br />Ice Cooler”! <br />Weler <br />Signatu <br />Rinse Watar <br />I Soap dispenser <br />i Propane Tank <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 event r/ f <br /> <br />Date <br />I am providing the follownig Items within my booth for the sanitary cleaning of food preparation utensil <br />1^3 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 />Title <br />z- I ExtraFood ConUlntnmustbo <br />tloradgMioaolToftbogroundr <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />EHD 16-02 Psge 8 of 11 TEMP EVEMT APP <br />07/3/17 <br />SANJOAQUIN <br />------COUNTY------ <br />. ■ G/Cfitnoss gra'.-.-r, 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 />E Ice chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify)___ <br />I Culling Board <br />Names of re^ronsible pereonsto be^present in booth during all hours of operation: