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Environmental Health Department <br />11. <br />OR <br />.. 12. <br />13. <br />Completed by: 14. <br />TitleSignature <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />BieacnPropane Stove <br />4 <br /> <br />Propane Tank <br />Bleacb and WaterRinse Water <br />Fire Extinguisher <br />TEMP EVENT APPPaqe 8 of 11 <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />1 ■ Vhree compartment sink, <br />t <br /> Three deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for a bleach <br />solution (one tabtespoon of bleach per gallon of water). <br />N^)etergent, bleach, and wiping cloths (cleaning towels) <br />OTub 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 />Stem© w/Chaffing <br />Osh <br />Extra <br />Waler <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach & water (or <br />Storing wiping cloths <br />5-20 Gai <br />Hand wash Water <br />Booth must be on <br />Concrete, Asphalt. <br />Plywood, or a Tarp. <br />SANJOAQUIN <br />------COUNTY------- <br />Greatness grows 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 />' Wee chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify) _____________________________________________ <br />O’?: <br />Ice Cooler ; <br />‘•Important** <br />Soap and Water <br />Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />[Vbne separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Paper towels and pump-style soap container. <br />•sent in booth during all hours of operation. ? ■ * <br />10. <br />1Extra Ice Bags & Food Containers must be ■ <br />stored 6 inches off of the ground1 ■ <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420) F 209 464-0138 | www.sjgov^org/ehd <br />EHD 16-02 Paqe 8 of 11 TEMP EVENT Al <br />Names of responsible-persons to <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 of <br />preparation and operation. Return original to festiynl coordinator three weeks priorjo <br />this event. <br />Health Permit