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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />13. <br />Completed by:14.Datere <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />JCutting Board <br />Bleach <br />Propane Stove <br />~T ' <br />Bleach and WaterRinse Water <br />Ice Cooler <br />Stockton, California 95205 | <br />y _______ * <br />3 <br />-----71 <br />I <br />i <br />I <br />i <br />1868 E. Hazelton Avenue | <br />EHD 16-02 <br />07/3/17 <br />Extra <br />Water <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 /> Other (specify)-— <br />5-20 Gal. <br />Hand wash Waler <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />Sterno w/Chaffing <br />Dish <br />SAN JOAQUIN <br />-------COUNTY- <br />5 Gal Hand wash <br />Wastewater Container <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Garbage <br />Can <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 />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />-k] Water <br />One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />H?Eaper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation: <br />**lm portant** <br />Propane Tank I^4 <br />r ~ -----------—------ <br />Extra Ice Bags & Food Containers must be <br />stored 6 inches off of the ground! <br /> <br />_______ <br />_____ ....... r— <br />Please make a copy of this application in <br />h/ -- checklist must be in the booth at all hours of <br />’eraton. Return original to festival coordinator three weeks priorjo <br /> <br />Title <br />T 209 468-3420 1 F 209 464-0138 | www.sjcehd.com <br />Page 8 of 11 TEMP EVENT APP <br />All food vendor booths are subject to inspection, <br />preparation for this event. A copy of this c..— <br />preparation and ope.. <br />this event. x "' ' <br />Sign <br />mil ' I HI......___________________