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<br />SAN JOAQUIN Environmental Health Department <br />10 <br />11 <br />OR <br />12 <br />Water supply dispenser with warm water at a minimum of WOT (i e 5-20 gallon container with spigot) <br /> One separate tub (bucket or basin) for the collection of nnse/wastewater <br />Paper towels and pump-style soap container <br />13 <br />•‘Important** <br />Completed by 14 <br />Paper Hand Toweia <br />Propane Steve <br />Propane T ank <br />©laacJr and <br />San/hzar bwcka! <br />t4eaeh X ««tei «or <br />«cnng aapeig Jotbs <br />EHO 16-02 <br />06/19/19 <br /> Three deep tubs (basins 6-8 inches minimum), one for soapy water, one for nosing and one for a bleach <br />solution (one tablespoon ot bleach per gallon of water) <br /> Detergent bleach and wiping cloths (cleaning towels) <br /> Tub to store wiping cloths in bleach solution <br />Stemo <br />D*- <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth <br />Lxtft <br />5 Gat Hand <br />AMsseviaie Coatamr <br />5-20 Gal <br />Kano *3«n Water <br />___-____:__ <br />Health Permit <br />Ice Cooler <br />Title <br />lapi pi ovidiug the folluwiiig liums wltliin niy buutti foi thu saiiltaiy clbanlfiQ of food prepaiatton utensil <br />0 Three compartment sink <br />]_. |fl"! <br />Booth must be on <br />Concrete Asphalt <br />Plywood or a Tarp <br />I am providing the following cold temperatuie 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 St Refrigerator <br />EfRefrigerated truck O Ice bath and tubs <br /> Other (specify) __________________________— <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 />this event, , / i <br /> <br />Signature Title Date <br />1868 E Hazelton Avenue | Stockton California 95205 | T 200 488-34201 F 209 464-0138 | www sjgov org/ehd <br />“.■C'OCT Page 8 eV 11 TEMP EVENT APP <br />_______________- ; <br />4 Foo* ConiMf* mtMf to ■ <br />dtoto fl off ot the jruvnf <br />Scan •■M Wa» R>na* WHO <br />—- <br />Garbage <br />Can <br />Narnesxif responsible peisons to be present in boolti dunng all tiours of operation <br />CzaIxJOIT.l)