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to. <br />11. <br />OR <br />12. <br />13. <br />••Important** <br />14.Completed by: <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />BleachPropane Stove <br />Bleach and WaterSoap and Waler <br />Rre Extinguisher <br />TFMP EVENT—"XM it M <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />Stemo w/Chaffing <br />Dish <br />Exn <br />Water <br />5-20 Gal. <br />Hand wash Water <br />Booth must t» <br />Concrete, Ass <br />Plywood, or a <br />Garbage <br />Can <br />SGaiHandwMh <br />Sanitizer bucket- <br />bleach & water fry <br />Storing wiping cloths <br />Environmen1^4ealth Department <br />0 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 />.jfl Detergent, bleach, and wiping cloths (cleaning towels). <br />£3 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 />Jgfwater supply dispenser with warm water at a minimum of 100oF (i.e. 5-20 gallon container with spigot). <br />JR&ne separate tub (bucket or basin) for the collection of rinse/wastewater. <br />^Paper towels and pump-style soap container. <br />I868E Hazelton Avenue I Stockton, California 952051 T 209 468-34201 F 209464-0138 | www.sigov.orfl/eN" <br />’ o—i^tt TEMPEVENT— <br />zz <br />Rinse Water <br />iparationJor this event. A copy of this checklist must be in the booth at all hours of <br />iparatkln anX operation. Jjejum original to festival coordinator three weeks prior to <br />-7-zr-/^ <br />Signature / Title Date <br />SANJOAQUil <br />— COUNTY™ <br />grows ^ene. <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 />^Jce chests Q Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify)____________________________ <br />Ice Cooler <br /> / troodCdntenw»fflWfite ■ <br />«mm Tank ----- ------ <br />Names of responsible persons to be present in booth during aH hours of operation:X>av£ <br />All food vendor booths are subject to inspection. Please make a copy of this application in <br />preparationjor this event. A copy of this checklist must be in the booth at all hours of <br />preparai <br />this ev<