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Environmental Health Department <br />10. <br />nitary cleaning of food preparation utensil11. <br />OR <br />12. <br />13. <br />this event. <br />Completed by: ■/_14. <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Bleach <br />Propane Stove <br />0 <br />Propane T ank <br />Bleach and WaterSoap and Water <br />Fire Extinguisher <br />Ice Cooler <br />TEMP EVENT APR <br />I am providing the <br />booth: <br />Sterno w/Chaffing <br />Dish <br />Extra <br />Water <br />5 Gal Hand wash <br />Wastewater Container <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />5-20 Gal. <br />Hand wash Water <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />SAN JOAQUIN <br />------COUNTY------- <br />Extra Ice Bags S. Food Containers must be <br />stored 6 inches off of the ground! B <br />5 <br />Rinse Water <br />1868 E. Hazelton Avenue | Stockton. <br />EHD 16-02 <br />06/19/19 <br />California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov org/ehd <br />Page 8 of 11 TEMP EVENT Al <br />.— <br />Garbage <br />Can <br />‘‘Important** <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />□ Three compartment sink. <br />Efrhree 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 />0.Detergent, bleach, and wiping cloths (cleaning towels). <br />IT/Tub to store wiping cloths in bleach solution. <br />following for adequate hand washing facilities, but separate from utensil wash within my <br />Greotness 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 41OF temperature): <br />[3 Ice chests Qi Refrigerator Q Q/V\Z5! ( <br />[TZf Refrigerated truck G Ice bath and tubs <br />□ Other (specify)______________—-------------------------------------------------------- <br />S/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 />Names of responsible persons to be present in booth during all hours oi operation. <br /> t 1 . NO€-_____ _________________ <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 /> <br />Title DateIgnature <br />Cutting Board