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Environmental Health Department <br />11. <br />OR for rinsing and one for a bleach <br />• 12. <br />basin) for the collection of rinse/wastewater. <br />13. <br />Completed by: 14.Date <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />Propane Stove <br />Propane Tank <br />Bleach and WaterRinse WaterSoap and Water <br />Fire Extinguisher <br />Ice Cooler <br />Sterno w/Chaffing <br />Dish <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />5-20 Gal. <br />Hand wash Water <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />Booth must be on <br />Concrete, Asphalt. <br />Plywood, or a Tarp. <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />• — - - - ii 63/ Extra Ice Bags & Food Containers must be ■ <br />_________________—K stored 6 inches off of the ground! ® — <br />1868 E. Hazelton Avenue I Stockton, California 95205 | T <br />Q z-i <br />EHD 16-02 <br />** Im porta nt** <br /> Three deep tubs (basins 6-8 inches minimum), one for soapy water, one <br />solution (one tablespoon of bleach per gallon of water). <br />H-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 />~ 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />n o TEMP EVENT APPPage 8 of 11 <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 />JXf Ice chests Refrigerator <br />O Refrigerated truck Ice bath and tubs <br /> Other (specify)._ ___________ <br />SANJOAOUIN <br />■' ------COUNTY------ <br />Greotness grows here <br />10. <br /> 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 <br />[jfpaper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation. <br /> <br /> <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 o <br />preparation and operation. Return original to festival coordinator three weeks pnorjo <br /> <br />Signature Title Date <br />Bleach