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Environmental Health Department <br /> COUNTY <br />Greatness <br />10. <br />11. <br />OR <br />12. <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 basin) for the collection of rinse/wastewater. <br />Paper towels and pump-style soap container. <br />13. <br />Completed by: 14. <br />Signature <br />I <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />BleachPropane Stove <br /> FT i <br />Propane Tank <br />Bleach and WaterSoap and Water <br />Fire Extinguisher <br />Ice Cooler ~ <br />Rinse Water <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />SANJOAQUIN <br />Sterno w/Chaffing <br />Dish <br />Refrigerator <br />Ice bath and tubs <br />Extra <br />Water <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 />5-20 Gal. <br />Hand wash Water <br />Title <br />Q <br />B <br />Health Permit <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 />Reparation and operation. Return original to festival coordinator three weeks prior to <br />thiKeyemt. <br />Names of responsible persons to be present in booth during all hours of operation: <br />______ yRcxfi,r d-.u __________________ <br />**lmportant** <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />^4] Three compartment sink. <br /> 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 />O Tub to store wiping cloths in bleach solution. <br />Extra Ice Bags & Food Containers must be <br />stored 6 inches off of the ground! <br />- <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 APR <br />07/3/17 <br />TidoXd' 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 /> Ice chests 'Q <br /> Refrigerated truck <br /> Other (specify)