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Environmental Health Department <br />10. <br />I <br />11.I^m^roviding the following items within my booth for the sanitary cleaning of food preparation utensil <br />OR <br />12. <br />'ater supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />•ne separate tub (bucket or basin) for the collection of rinse/wastewater. <br />B-P^per towels and pump-style soap container. <br />13.ersons to be present in booth during all hours of operation: <br /> <br />14. Completed by: <br />Signi <br />IHealth Permit <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />Propane Stove Bleach <br />Propane Tank <br />Bleach and Water <br />Fire Extinguisher <br />Ice Cooler <br />_z <br />Soap and Water Rinse Water <br />Extra Ice Bags & Food Containers must be <br />stored 6 inches off of the ground! <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach & waler for <br />storing wiping cloths <br />Booth must be on <br />Concrete. Asphalt. <br />Plywood, ora Tarp. <br />Extra <br />Waler <br />Sterno w/Chafflng <br />Osh <br />Names of responsible persons to <br />5-20 Gal. <br />Hand wash Water <br />. k <br />' SAN JOAQUIN <br />COU NTY <br />^am^providing the following for adequate hand washing facilities, but separate from utensil wash within my <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 Refrigerator <br />S'Pefngerated truck Ice bath and tubs <br /> Other (specify)____ <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 /> 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 />07/3/17 02 Pa9e 8 °f 11 TEMP EVENT APP <br />‘‘Important** 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 event. <br />ficx/rn £ - / 'Us <br />Title Date