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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />0 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. <br />14. <br />Date <br />I Papor rt»nd Tow«l« <br />Soap dltpanwr <br />CutAno Boart 1 BleachPropane Stove <br />it Wii.'wrw <br />Propene Tank <br />Steach and WaterRlnae Water <br />Fire ExflnQulaher <br />Ice Cooler <br />3 <br />TEMP EVENT APPPage 8 of 11 <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Slemo vnfChaffing <br />Dish <br />5 Gal Handwaih <br />Wastewater Container <br />6-20 Gd. <br />Handwteh Water <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <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 />Q^-Refrigerated truck Ice bath and tubs <br /> Other (specify) <br />8*nfttz»r buckrt- <br />bKCKh & wMter for <br />Modng wiping doth* <br />SAN JOAQUIN <br /><■: otj h ■*•••'• <br />Us <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 />Extra la B»t3 4 ftxxf Coni«M«re muM <br />staid e Inchts off or «• gmundl <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />Three compartment sink. <br />__J_ <br />Soap and Water <br />1868 E. Hazelton Avenue I Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />EHD 18-02 Page 8 Of 11 TEMP EVEN! <br />07/3/17 <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 />Completed by: <br />r.-r <br />Health Permit - <br />Garbage <br />Can <br />Names of responsible persons to be present in booth during ail hours of operation: <br />••Important**