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Environmental Health Department <br />11. <br />OR <br />12. <br />® Paper towels and pump-style soap container. <br />13.Names of responsible persons to be present In booth during all hours of operation: <br />14. <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />BleachPropane Stove <br />Propane Tank <br />Soap and Water Rinse Water <br />Flro Extinguisher <br />SI Water supply dispenser with warm water at a minimum of 100°F (l.e. 5-20 gallon container with spigot). <br />S. One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Extra too Bags i Food Containers must be <br />stored 6 Inches ott ot the groundl <br />StemovdChaffing <br />Olah <br />Extra <br />Water <br />5 Gal Hand wash ' <br />Wastewater Container <br />Title <br />Garbage <br />Can <br />SanHizor bucket­ <br />bleach & water for <br />storing wiping cloths <br /> Booth must be on <br />Concrete, Asphalt, <br />Plywood, ora Tarp. <br />/ A <br />Ice Cooler | <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. <br />Completed by: --------------- <br />‘ < Signature Date <br />SAMAQUIN <br />t -----COUNTY------ <br />Greotness grows here. <br />10. lam providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />if <br />5-20 Gal. <br />Hand wash Water <br />‘‘Important** <br />. S' <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <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 />S Detergent, bleach, and wiping cloths (cleaning towels). <br />® Tub to store wiping cloths in bleach solution. <br />------1 I IBleach and Water S B <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420) F 209 464-0138 | www.sjcehd.com <br />EHD 16-02 Pago 8 of 11 TEMP EVENT APP <br />07/3/17 <br />45°F (if food is used the following day, maintain below 41’F temperature): <br />0. Ice chests g| Refrigerator <br /> Refrigerated truck Ice bath and tubs • r, s . <br /> Other (specify)Mo <br />I am providing the following Items within my booth for the sanitary cleaning of food preparation utensil <br />® Three compartment sink.