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Environmental Health Department <br />10. <br />11. <br />OR <br />12 <br />13. <br />•'Important** <br />14.Completed by: <br />Signature Title Date <br />Paper Hand Towels <br />Sow eispetnser <br />ktteacnPropane Stove <br />2 <br />Prwane Tank <br />and Water <br />Fire Extncjwjfter <br />Ice Cooler <br />EHD 16-G2 <br />06/19/19 <br />Sterne wOwW«ng <br />Dish <br />Extra <br />Water <br />5 Gal Hand wasn <br />Wastewater Ccnlatner <br />5-20 Gai <br />Hand wash Water <br />SanKtzer bucFet- <br />bktach & water for <br />storing w»png doth# <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 />45°F (if food is used the following day, maintain below 41 “F temperature): <br />0Tce chests Q Refrigerator <br />□ Refrigerated truck ETce bath and tubs <br />S'Other (specify)_________________ <br />SAN JOAQUIN <br />COUNTY <br />AN food vendor booths are subject to inspection. Please make a copy of this application in <br />preparation for thi^event. A copy of this checklist must be in the booth at all hours of <br />preparation and^ef^tiqB? Return original to festival coordinator three weeks prior to <br />this event. <br />1 <br />Rtnso Water <br />Health Permit <br />STZVater supply dispenser with warm water at a minimum of 10O ’F (i.e. 5-20 gallon container with spigot). <br />S^ne separate tub (bucket or basin) for the collection of rinse/wastewater. <br />©'Paper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation: <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />□ Three compartment sink. <br />... ■' ........................................ <br />Ice Begs S, Fea) Conamsrs must be <br />sttml S inctsts ntfetttn ground' <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 />©6etergenl, bleach, and wiping dullis (cleaning towels). <br />©tub to store wiping cloths in bleach solution. <br />rYtI <br />Soap and W«w Garbage <br />Can <br />1868 E. Hazelton Avenue | Stockton. California 95205 | T 209 468-3420) F 209 464-0138 | www.sjgov.org/ehd <br />—-‘--2 Page 8 o(11 TEMP EVENT APP <br />■--------------- —~'X <br />Booth must be on <br />Concrete, Asphalt. <br />Plywood, or a Tarp. <br />Culling Hoard