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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.Names of responsible persons to be present in booth during all hours of operation: <br />••Important** <br />Completed by.14. <br />Health Permit <br />Paper Hand Towels <br />1BleachPropane Slow <br />I'ropane I an> <br />Fire ExUopuistier <br />Ice Cooler <br />TEMP EVENT APP <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 /> Ice chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify)___ <br />Ettra Ice Bags 4 Food Conltuneit mull be <br />stored 6 mchec oM ol the grounO' <br />Slemo w/Chatting <br />Doh <br />Extra <br />Water <br />Garbage <br />Can <br />Booth must be on <br />Concrete. Asphalt. <br />Plywood, or a Tarp <br />5 Gal Hand wash <br />Wastewater Container <br />5-20 Gal <br />Hand wash Waler <br />Sanitizer buOet- <br />bleacn 5 waler tor <br />storing wiping Ooms <br />SAN JOAQUIN <br />COUNTY— <br />Date <br />IT II <br />/ <br />Rinse Water <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />O Three deep tubs (basins 6-8 inches minimum), one for soapy waler, 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 />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. / x <br />_________ / rf n, f y r <br />Signature__________________Title <br />1868 E Hazelton Avenue | Stockton. California 95205 | T 209 468-3420 1 F 209 464-0138 1 www.sjgovTxg/ehd <br />EHO 16-0? Page 8 ol 11 Z'. <br />| Soap dispenw j <br />rT L <br />I <br />Soap and Wale*