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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />I^lWater supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />13. <br />**lmportant** <br />Completed by: 14. <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />BleachPropane Stove <br />u <br />Propane Tank <br />Rinse Water Bleach and Water <br />Fire Extinguisher <br />Ice Cooler <br />) <br />EHl) 16-02 <br />07/3/17 <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Extra h-e Safls 5 Food Containers must be <br />stored 6 inches off of the graontf <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 eveni <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Booth must be on <br />Concrete, Asphalt. <br />Plywood, or a Tarp. <br />£p£One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />fJ^Paper towels and pump-style soap container. <br />5-20 Gal. <br />Hand wash Water <br />Sanitizer bucket­ <br />bleach 4 waler for <br />stonng wiping cloths <br />Sterno w/ChaflingDish <br />Extra <br />Water <br />SAN JOAQUIN <br />-COUNTY------ <br />Title Date <br />Names of resppnaible £ersop<lo be present in booth during all hours of operation:_____yZ^-6 _________ <br />7 <br />Soap and Water <br />.‘rationed <br />Signature <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <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 />Sice chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify) <br />13-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 />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />~ ~ *• - -2 Page 8 of 11 TEMP EVENT APP