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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />0 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 basin) for the collection of rinse/wastewater. <br />□ Paper towels and pump-style soap container. <br />13. <br />Return original to festival coordinator three weeks prior to <br />8/30/201814.Completed by: <br />Date <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />", <br />BleachPropane Stove <br />Propane Tank <br />Bleach and Water <br />Fire Extinguisher <br />Ice Cooler <br />Soap and Water Rinse Water <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />45OF (if food is used the following day, maintain below 41 °F temperature): <br />0 Ice chests 0 Refrigerator <br />0 Refrigerated truck 0 Ice bath and tubs <br />0 Other (specify)_ <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <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 />Names of responsible persons to be present in booth during all hours of operation: <br />Ava Simpson, Sherri Fisher, Don Maszewski <br />Stemo w/Chaffing <br />Dish <br />Extra <br />Water <br />5-20 Gal. <br />Hand wash Water <br />SAN JOAQUIN <br />COUNTY <br />Event Coordinator <br />Title <br />______________________ <br />Extra Ice Bags & Food Containers must be <br />stored 6 inches off of the ground! <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 />preparatibrT^nd operation. <br />this e^ent. J ( ' <br />Signature <br />‘‘Important** <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />0 Three compartment sink. <br />0 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 />0 Detergent, bleach, and wiping cloths (cleaning towels). <br />0 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 />EHD 16-02 Page 8 of 11 TEMP EVENT ARP <br />07/3/17