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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 /> One separate tub (bucket or basin) for the collection of rinse/wastewater. <br /> Paper towels and pump-style soap container. <br />13. <br />“Important** <br />Owner14.Completed by: <br />Signature Title <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />BleachPropane Stove <br />Bleach and Water <br />Fire Extinguisher <br />Ice Cooler <br />Names of responsible persons to be present in booth during all hours of operation: <br />Sam Hissayko <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 0 Refrigerator <br />0 Refrigerated truck Ice bath and tubs <br /> Other (specify) <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Stemo w/ChaffingDish <br />Extra <br />Water <br />5 Gal Hand wash <br />Wastewaler Container <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach & water for <br />stonng wiping cloths <br />5-20 Gal. <br />Hand wash Water <br />Booth must be on <br />Concrete. Asphalt. <br />Plywood, or a Tarp <br />SAN JOAQUIN <br />- COUNTY- <br />LT U <br />Rinse Water <br />Propane T ank <br />04/17/19 <br />Date <br />LZ <br />Soap and Water <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 />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420] F 209 464-0138 | www.sjcehd.com <br />EHD 16-02 Page 8 of 11 TEMP EVENT APP <br />07/3/17 <br />Extra Ice Bags & Food Containers must be , <br />stored 6 inches off of the ground' 1 <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-afl^Loperation. Return original to festival coordinator three weeks prior to <br />this evern. / n <br />Cutting Board