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Environmental Health Department <br />10 <br />lar/ providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />Lx Three compartment sink. <br />11 <br />OR <br />one for rinsing and one for a bleach <br />12. <br />13. <br />“Important** <br />14.Completed by: <br />Paoer Hand Towels <br />Culling Beard 3Propane Stove <br />II <br />Propane Tank <br />Bleach and Water <br />Fire Extinquishor <br />5 <br />Sterno w/Chaffing <br />D.sh <br />5 Gal Hand wash <br />Wastewater Conlainor <br />Garbage <br />Can <br />Booth must be on <br />Concrete, Asphalt. <br />Plywood, or a Taro <br />5-20 Gal <br />Hang wash Water <br />Sanitizer buoet- <br />oieac* & water fcr <br />storing wiping cloths <br />Exira <br />Water <br />Health Permit 3 <br />SAN JOAOUIN <br />C O U N T Y <br />I <br />/ — <br />I Ice Cooler <br />10 <br />1 <br />Rinse Water <br />I am providing the following cold temperature control for (he 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 H Refrigerator <br />L3 Refrigerated truck Ice bath and tubs <br /> Other (specify) ____________________ <br />Scan and Water <br /> Three deep tubs (basins 6-8 inches minimum), one for soapy water, <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 facilities, but separate from utensil wash within my <br />booth: <br />Efwater 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 />tfpaper towels and pump-style soap container. <br />California 95205 I T 209 468-3420 | F 209 464-0138 | www sjcehd com <br />Page 8 of 11 TEMP EVENT APP <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 evegt,. z’Z <br />x Signature Title <br />1868 E Hazelton Avenue | Stockton, <br />EHD 16-02 <br />07/3/17 <br />| Bleach <br />Names of responsible nersons to be present in booth during all hours of operation <br />i\\vA,S Mtd/APv <br />I Soap dispenser j <br />Extra Ico Bogs & Pood Contomors must be 1$ <br />stored 6 inches off of the ground' <br />ate