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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />E Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />H One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />H Paper towels and pump-style soap container. <br />13. <br />*4lmportant** <br />Completed by:14. <br />idna’re <br />I Papor Hand TowoIb <br />Soap dispenser <br />BleachPropane i love <br />Propane Tank <br />Fire Extinguisher <br />TEMP EVENT APPPage 0 of 11 <br />Ice Cooler <br />-A <br />p I <br />Soap and Water <br />/ <br />Rinse Waler <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Sterno w/Chafhng <br />Dish <br />> event, <br />leratior/ <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach & waler lor <br />storing wiping cloths <br />Booth must be on <br />Concrete, Asphalt. <br />Plywood, or a Tarp. <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 />H Ice chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify)_ <br />Extra <br />Water <br />5-20 Gal <br />Hand wash Water <br />SAN JOAQUIN <br />C O U N ’ Y <br />_ <br />Extra Ice Bags & Eoo0 Containers must be <br />s'ored 6 inches of/ of the gnjundl <br />[ <br />Health Permit <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />E<ff*Three deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for a bleach <br />sobdtion (one tablespoon of bleach per gallon of water). <br />0 Detergent, bleach, and wiping cloths (cleaning towels). <br /> Tub to store wiping cloths in bleach solution. <br />urn original to festival coordinator three weeks prior to <br />Vj Title Date <br />All food vendor booths are subject to inspection. Please make a copy of this application in <br />preparation for this eventy A/ opy of this checklist must be in the booth at all hours of <br />preparation and <br />this event. \ <br />■ <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />EHD 16-02 <br />07/3/17 <br />Culling Board ------- - <br />to <br />Names of responsible persons to be present in booth during all hours of operation: <br />- ----------------------------