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Environmental Health Department <br />10. <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 <br />] <br />]Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />BleachPropane Stove <br />Bleach and Water <br />Fire Extinguisher <br />TEMP EVENT APR <br />Soap and Water Rinso Water <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Extra <br />Water <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Stemo w/Chaffing <br />Dish <br />5-20 Gal. <br />Hand wash Water <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping doths <br />SAN JOAQUIN <br />------COUNTY------- <br />Grcotnc?i grows here <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 />0 Ice chests 0 Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify) ___________________________________________________ <br />Title <br />Propane Tank <br />4*7 <br />■ a <br />Ice Cooler <br />**lm porta nt**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, y f / / x /'‘•£^2^ U <br />Date <br />| Health Permit <br />Names of responsible persons to, be present in booth during all hours of operation: <br />_____7^L^l (tn Gsc-- ______________ <br />ExZra /co Bags & Food Containers must be ■ <br />stored 6 inches otf ot the ground! <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />EHD 16-02 Pa9e 8 of 11 TEMP EVENT <br />07/3/17 <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />0 Three compartment sink. <br />[LKfhree 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 />Q'petergent, bleach, and wiping cloths (cleaning towels). <br />[TfTub to store wiping cloths in bleach solution.