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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />^0One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />13. <br />“Important** <br />Completed by:14. <br />Paper I land Towels <br />Soap dispenser <br />Cutting Board <br />Bleach <br />Propane Stove <br />0J <br />Propane Tank <br />Bleach and Waler <br />Fire Extinguisher <br />Ice Cooler <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com^ <br />Stcmo w/Chalfing <br />Dish <br />Extra <br />Water <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Sanitizer bucket <br />bleach 8 waler (or <br />Storing wiping cloths <br />Booth must be on <br />Concrete. Asphalt, <br />Plywood, or a Tarp. <br />1____------------- <br />Health Permit <br />SAN JOAQUIN <br />COU NTY <br />Rinse Water <br />J-----—-——flExtra Ice Bags & Food Containers must be <br />stored 6 inches off of the ground! 1 <br />__J <br />Soap and Water <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 />01ce chests Refrigerator <br /> Refrigerated truck >0Tce bath and tubs <br /> Other (specify). _ <br />Water supply dispenser with warm water at a minimum of lOO ’F (i.e. 5-20 gallon container with spigot). <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <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 />bleach, and wiping cloths (cleaning towels). <br />^01 ub 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 />Paper towels and pump-style soap container. <br /> <br />Name^o^^^^ <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 /> preparatio^aQdoperation. Return original to festival coordinator three weeks prior to <br /> <br />5-20 Gal. <br />r— Hand wash Water