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Environmental Health Department <br />i <br />10. <br />11. <br />OR <br />12. <br />‘‘Important** <br />(Qfaihzpi <br />Signature U Title date <br />14.Completed by: <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />Propano Stove <br />it I <br />Rinse Water Bleach and Water <br />Fira Extinguisher <br />Ice Cooler <br />Health Permit <br />Extra <br />Water <br />5-20 Gal. <br />Hand wash Water <br />Sanitizer bucket* bleach & water for <br />storing wiping cloths <br />Stemo w/Chalfing <br />Dish <br />5 Gal Hand wash <br />Wastewater Container <br />i£ <br />I " ■'"' • -1? ~ -» <br />Extra ka Bags & Foad Containers must be <br />stored 6 inches off of the ground! <br />Propane Tank <br />Jui <br />Garbage <br />Can <br />TT^ (Z <br />Soap end Water <br />“——x <br />Booth must be on <br />Concrete. Asphalt, <br />plywood-oraTarp- t <br />. ■ SAN.JOAQUIN <br />■'I . ------COUNTY— <br />iC',-(>i eotm’.i:', grovrs 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 following day, maintain below 41"F temperature): <br />'j^-teerbhests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify) <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 />lam providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />1868 E. Hazelton Avenue | Stockton, California 952051 T 209 468-34201 F 209 464-0138 | www.sjgov.org/ehd <br />0Page 8 of 11 TEMP EVENT APP <br />^anr^providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />■^Water supply dispenser with warm water at a minimum of 10OT (i.e. 5-20 gallon container with spigot). <br />E^Dne separate tub (bucket or basin) for the collection of rinse/wastewater. <br />^Raper towels and pump-style soap container. <br />13- Names of resp^pblep^on^>^be^esen^m^oth during all hours of operation: <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.