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Environmental Health Department <br />11. lam providing the following items within my booth for the sanitary cleaning of food prepatation utensil <br /> Three compartment sink. <br />OR <br />12. <br />Q Water supply dispenser with warm water at a minimum of 100'F (l.e. 6-20 gallon container with spigot). <br /> One separate tub (bucket or basin) for the collection of rinseAvastewater. <br /> Paper towels and pumi te eoap 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 W <br />Papw Hvtd T<nral» <br />Boap dtspanser <br />Cuttinfl Beard <br />BleachRropana Stave <br />Propane Tadt <br />Bleach and WaterRJnn Water <br />FlTO ExjInfluWw <br />TEMP EVENT APP <br />Im Bigi OanWnm mM Hi <br />MM e Mm ottofffn gmundl <br />Stamo wfChafllng <br />ash <br />5 (W Handwash Wutowtef Contekior <br />&20 Gal <br />Hand waali Water <br />Garbage <br />Can <br />talttw buotcai- <br />tteuti Awftwfor <br />atortng dotw <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp- <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 />I am providing the following for adequate hand washing feolUtlss, but separate from utensil wash within my <br />booth: <br />Ice Cooler J <br />Signature Title <br />Heap and Water <br />r'-’ 'Q. <br />■ • ■■■- Ip <br />41a <br />Date <br />AH 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 wegkl prior to <br /> thlsevent^^ <br />■V SANJOAOUIN <br />.r: .. -----COUNTY'------ <br />Greotness grows here. <br />10. lam providing the following cold temperature control for the coH holding of potentially hazardous foods below <br />45°F (if food is used the following day, maintain below 41 °F temperature): <br /> loe chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify) _______ ___________. <br />1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-34201 F 209 464-0138 | www.sjcehd.com <br />B4D1B-02 P«fl»8(rf11 <br />07/3/17 <br />ff'Til ••. ~7 y -1