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Environmental Health Department <br />10. <br />Z>/0/ <br />11. <br />OR <br />12. <br />13. <br />“Important** <br />14.Completed by: <br />Paper Hand lowals <br />CuUlnp Board <br />i'iiioacnPropane Stow <br />Propane Tank <br />Blench ana Waler <br />]Fue Catinquishor <br />Ice Cooler <br />^Water supply dispenser with warm waler at a minimum of lOO’F (i.e. 5-20 gallon container with spigot). <br />J^One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Paper towels and pump-style soap container. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <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 />O Ice chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br />Q Other (specify)____________________________ <br />Storno w/Chalfmii <br />OiM <br />ExIm <br />Watoc <br />5 0 .tl H»nd waih <br />Wostow.Hoi Conla'ner <br />Title <br />Garbage <br />Can <br />SanHitoc BuCXol- <br />bleach & tvnlec tor <br />storing wping cloths <br />Booth must bo on <br />Concroto, Asphalt, <br />Plywood, or a Tarp <br />F.ntnr /co « Food Cooloioors must bo <br />stored 6 inthea oN ol tlio ground! <br />tr-20 GbI. <br />Hind w»»h Wntor <br />Names of responsible persons to be present in booth during all hours of operation: <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />Q 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 />SAN JOAQUIN <br />GOU NI Y <br />3c7 <br />Soap and Water <br />iu1 <br />R-n»a Water <br />Health Permit <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 bo in the booth at all hours of <br />preparation and operation. Return original to festival coordinator three weeks prior to <br />this event. -n/ /7______/(/■ //.//>_______fawicei-_____ffyfAz <br />Signature_____Title___________'Date <br />1868 E. Hazelton Avenue | Stockton. California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />EH016-02 PngoBofll • TEMP EVENT APP <br />06/19/19 <br />Soap disr.onscr