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2 of 2 <br />Environmental Health Department <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 />•a <br />14.Completed by: <br />Date <br />Health Permit <br />Propane Tank <br />Ice Cooler <br />Scanned with CamScanner <br />Wtf ■jMi Comt»np* <br />tlonng Oothe <br />I <br />Sow an« MM* <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensi <br /> Three compartment sink. <br />Dnh <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 Weach per gallon of water). <br /> Detergent, bleach, and wiping cloths (cleaning towels). <br /> Tub to store wiping cloths in bleach solution. <br />Garbage <br />Can <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Booth must be on <br />Conciete. Asphalt. <br />Plywood, or a Tarp <br />SAN JOAQUIN <br />C OUN 1 •» <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 foltowng day. maintain below 41'F temperature): <br />p^4ce chests Refrigerator <br /> Refrigerated truck bath and ,ubs <br /> Other (specify) <br />I BMKh <br />SfcXPtf 6 *X/WS Off o/to 0TIM4W <br />booth dunng all hours of operation: <br />I 'AeI | <br />1868 E Hazelton Avenue | Stockton. California 95205 | T 209 468-3420 | F 209 464-0138 | www sjcehd com <br />EHOH02 P^Boril lEMPEVtNT APP <br />0713/17 <br />T IZ <br />I RmM <br />MWij. <br />of responsible persons to be present in <br />j f _______Vr* <br />“Important** <br />Nanpsof <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 />SIS M <br />frAc-sOAlm iwo ( ~ rVM 4C\