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Environmental Health Department <br />10. <br />11. <br />OR for soapy water, one for rinsing and one for a bleach <br />12. <br />separate tub (bucket or basin) for the collection of rinse/wastewater. <br />13. <br />••Important** <br />Completed by:14. <br />Health Permit <br />Paper Hand Toweta <br />Soap dispenser <br />CuWog Board <br />BteadiPropane Stow <br />it <br />Fire Extinguisher <br />TEMP EVENT APP <br />Soap and Water <br />Stemo wiChaffing <br />Dish <br />5 Gal Hand wash <br />Wastewater Container <br />5-20 Gal <br />Hand wash Water <br />Garbage <br />Can <br />Booth must be on <br />Concrete. Asphalt, <br />Plywood, or a Tarp. <br />Sanitizer bucket- <br />Meach S water for <br />storing wiping doths <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />H^Three deep tubs (basins 6-8 inches minimum), one <br />solution (one tablespoon of bleach per gallon of water). <br />ZW Detergent, bleach, and wiping cloths (cleaning towels). <br /> Tub to store wiping cloths in bleach solution. <br />a <br />r3 <br />Rinse Water <br />Extra Ice Bags & Food Containers must be ■ <br />I stored 6 inches off o( the ground I M <br />Propane Tank <br />1868 E. Hazelton Avenue I Stockton. California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />EHD 16-02 Page 8 erf 11 TEMP EVEN! <br />07/3/17 <br />. ...V .'.^-.v... <br />| Bteadi and Water <br />A <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Kfwater supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />Ice Cooler <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 />^0O ^Signature Title Date <br />SANJOAOUIN <br />- - COUNTY — <br />G-ov.-'.-s <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 /> Ice chests ^3 Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify)__ ________________________________ <br />j^j'f’aper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation: <br />CkaoVpc __________________________ _________