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SAN ) O A Q U I N Environmental Health Department <br /> - C0UNTY <br /> 10. 1 am providing the following cold temperaftxe ooradl ffr lllfte cultd I icildi g mff pnMwti0y ifs tbalis bellcm <br /> 4, IF cif fr]Ad.is_ii.-sp th>ti followingad d .maril�iim <br /> Ice chests F4RefW <br /> ❑ Refrigerated Mick ❑ Ice tath we tis <br /> ❑ Other(specify) <br /> 11. 1 am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> ❑ Three compartment sink. <br /> OR <br /> ❑ Three deep tubs (basins 6-8 inches minimum). one fear soapy vaster, orae for dnsing and one for a bleach <br /> s-6%Aw forte of bhez&w galim of wales}- <br /> ❑ Detergent, bleach, and wiping cloths(cleaning towels). <br /> ❑ Tub to store wiping cloths in bleach solution. <br /> 12. 1 am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br /> booth: <br /> Water supply dispenser with warm water at a minimum of 100T (i.e. 5-20 gallon container with spigot). <br /> One separate tub(bucket or basin)for the collection of rinse/wastewater. <br /> -54:Paper towels and pump-style soap container. <br /> 13. Names of responsible perspristo be-a[esent,in^^bo h during all hours of operation: <br /> "Important" 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. Realm original to festival caooMb ator ttaree weeks prior to <br /> this a ent. <br /> 14. Completed by: <br /> Signatu TMe Date <br /> wiz Gilt: <br /> Health Permit <br /> Sterno w/Chaffinq, <br /> Dish Paper hand Towels <br /> Soap dispenser <br /> Cutting Board Saantuer bucket- <br /> bleach&water for <br /> Propane Stove Bleach stonng wiping cloths <br /> Booth must be on <br /> 11 Pat�we�IId:ar :1 ¢ <br /> \\ J 1 <br /> Propane Tank \ <br /> / ' I Soap and Water Rinse Water Bleach and Water Gat <br /> haW <br /> / Can <br /> Fire Extinguisher <br /> Extra i <br /> Water <br /> Ice Cooler 5C.WHand was <br /> b <br /> Extra Ice Bags&Food Containers must be Wastewater Container <br /> --- ---- stored 6 inches off of the ground! <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 T 209 468-3420 1 F 209 464-0138 I„ ww.w_sjf ehd.com <br /> EHD 16-02 Page 8 of i 1 E ffVM*7 TAIR' <br /> 07/3/17 <br />