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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />£3 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 />14.Completed by: <br />Popor Hand Towoli <br />Soap disponsor <br />Cdllinp Board <br />BleachPropane Stove <br />u <br />Propone Took <br />/Ihnso Woter Ulcach nnd Water <br />Flro ExttnniFsborG <br />Ice Cooler <br />EHD 16 0? <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Sterno w/Clw>ffingDish <br />Extra <br />Wnlor <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Booth must bo on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Sanitizer buckot- <br />bloach A water for <br />storing wiping cloths <br />SAN JOAQUIN <br />COU NIY <br />JSHSSHiHBMHSBBBBBBM <br />Extro fee Bags & Food Containois must l>0 <br />slorotl 6 inches ott ol Iho giound! <br />c <9 - <br />Title <br />_z <br />Soap nnd Waler <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 ovpnt - / <br />\-Sjt4jlAA-4 C /l.) <br />Signature Title Date <br />laaQESHfiHMBffiBEgJ <br />Health Permit J <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 />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />Throe compartment sink. <br />I am providing the following cold tompcrature 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 Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify) _________________________ <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />r.UDISO? PagoBofll TEMP EVENTAPP <br />5-20 Gnl. <br />HandwosliWutor <br />Names of responsible persons to be present in booth during all hours of operation: <br />mruckdlt ssq-3io - SB'S