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Environmental Health Department <br />11. <br />OR <br />12. <br />13. <br />“Important** <br />14.Completed by: <br />Date <br />I <br />Paper Hand Towels <br />Sosip cJIsponsor <br />Culling Board <br />BloochPropnno Stove <br />Fira tixtlnfiulshor <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />5 Gal I land wash <br />Wnstowalor Container <br />Garbage <br />Can <br />Smu'lizcrbuckot- <br />bloach & v/alcr (or <br />storing wiping cloths <br />Booth must bo on <br /> Concrelo, Asphalt, <br />Plywood, or a Tarp. <br />Water supply dispenser with warm water at a minimum of WOT (i.e. 5-20 gallon container with spigot), <br />[ZJ One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />'^fPaper towels and pump-style soap container. <br />Stomo w/Cha((ing <br />Dish <br />........ . -■ <br />Bleach and Water <br />Fxira Ico Ungs A rood Conlalnors must bo <br />stored 6 Inches oil ol the groundl <br />Health Permit p r <br />Propane Tank <br /> <br />1868 E. I lazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />El IO 1G-02 P.-igo 0 of 11 TEMP EVENT API’ <br />07/3/17 <br />. SANJOAQUIN <br />---COUNT Y------ <br /><l- <br />10. <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. i <br /> <br />1 Signature Title / <br />I Soap and Waler <br />[•------- <br />j j Binsn Water <br />Names of responsible persons to be present in booth during all hours of operation: <br />FcerA ________________________ <br />li-20 Gul. <br />5^ Hand wash W.'ilor <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 />]x^Tub to store wiping cloths in bleach solution. <br />Jam providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />0 Three compartment sink. <br />M 4: la <br />:--------------- <br />Ice Cooler t <br />______ .7 <br />•■^4 <br />Greutness 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 followiriQ day, maintain below 41 °F temperature): <br /> Ice chests ^^Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify)_