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Environmental Health Department5 <br />10. <br />11. <br />OR <br />12 <br />13.ssponstbk m.u <br />“Important" <br />14. <br />Iture <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />BleachPropane Stove <br />u <br />Rinse Water Bleach and Water <br />Fire ExtinguisherQ <br />Eitra lev Bags & Food Containers must be stored 6 inches off of the ground' <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />San.bzer bucket­ <br />bleach 4 water for <br />stonng wiping cloths <br />Stems w^Chatting <br />D»sh <br />5-20 Gal <br />Hand wash Water <br />z__.___ <br />Ice Cooler <br />jQ Water supply dispenser wih warn water at a minimum of 100“F (i.e. 5-20 gallon container with spigot). <br />One separate tub (bucket tor basin) for the collection of rinse/wastewater. <br />^Paper towels and pump-styte soap container <br />Names of responsible persons to tie present in booth during all hours of operation. <br />AU food vendor booths are subject to inspection. Please make a copy of this application in <br />prepara’ton 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 />Completed by:t <br />SANJOAQUIN <br />COUNTY <br />Greotness grows here <br />z <br />Soap and Water <br />Booth must be on <br />Concrete. Asphalt. <br />Plywood, ora Tarp <br />_____________> <br />rT~» <br />Greotness grows <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 />S4ce chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify) <br />Stjhree deep tubs (basins ShB inches minimum), one for soapy water, one for rinsing and one for a bleach <br />solution (one tablespoon of bleach per galiton of water). <br /> Detergent, bleach, and wiping ctotos (cleaning towels). <br /> Tub to store wiping cloths in bleach seduton. <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />W3 <br />I Propane Tank <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 APP <br />0743/17