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Environmental Health Department <br />10. <br />F ZE <br />11. <br />OR bleach <br />12. <br />V0VVater 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. <br />"Important** <br />Completed by: 14. <br />Date <br />Health Permit <br />Raper Hand ToweH <br />Cutting Board <br />BleachPropane Stove <br />it <br />Rinse Water <br />Fire Extinguisher <br />Ice Cooler <br />E»tra ice Bags A rood Containers must be <br />stored 6 inches off the ground' <br />Sterno w/Chafftng <br />Dish <br />5 Gal Hand wash <br />Wastewater Container <br />Sanfflzer bucket­ <br />bleach & waler tor <br />storing wiping cloths <br />SctinniKi with <br />3) CamScanner <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />^PTlhree compartment sink. <br />□ Three deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for a <br />solution (one tablespoon of bleach per gallon of water). <br />O Detergent, bleach, and wiping cloths (cleaning towels). <br />□ Tub to store wiping cloths in bleach solution. <br />Extra <br />Water <br />5-20 Gal <br />Hand wash Water <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />1 <br />Soap and Water <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 />07/3/17 <br />... <br />Ti& <br />SANJOAQUIN <br />'------COUNTY <br />, Grcotncsi grows here. <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 />O Ice chests ^^Refrigerator <br />Refrigerated truck O Ice bath and tubs <br />^PTOther (specify) <br />-----------------------Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp <br />Names of responsible persons to be present in booth during all hours of operation: <br />______fl 0 K A n _______________________ ____________—----------------- <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 priorjo <br />this event ✓) . <br />___________ ________________________________________ <br />Signature <br />Propane Tank <br />------------------------J <br />Garbage <br />Can <br />^=31