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Environmental Health Department <br /> <br />10. <br />11. <br />OR <br />12. <br />Q'Water supply dispenser with warm water at a minimum of 100’F (i.e. 5-20 gallon container with spigot). <br />13. <br />“Important** <br />Completed by: 14. <br />TitleSignature <br />Health Permit <br />PipatHMTonta <br />SoopdtepenMf <br />CutoriQ Board <br />Propene Stow <br />Propane Tank <br />BtMch and Water <br />z. <br />H'One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />H^Paper towels and pump-style soap container. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />Stemo wfChaffing <br />Senaxerbuctat- <br />bteeehi water for <br />Morfng wiring cMhs <br /> Extra <br />Water <br />5 Gai Hand wash <br />Wastewater Container <br />Booth must be on <br />Concrete. Asphalt. <br />Plywood, ora Tarp. <br />RAM Wafer <br />f <br />Soap and Water <br />5-20 Gte. <br />r- Hand waah Water <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 />O Detergent, bleach, and wiping cloths (cleaning towels). <br />Q Tub to store wiping cloths in bleach solution. <br />SAN JOAQUIN <br />COUMTY <br />Gr<’Ofnc5s qrdi-.s heii.. <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 />0lce chests Refrigerator <br /> Refrigerated truck 0lce bath and tubs <br /> Other (specify)___________________________________________________ <br />1868 E Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16-02 Page S ol 11 TEMP EVENT APP <br />I Exn Ice Bags i Food Contunn mat be || <br />uand6mmaHolt»voundl ■ <br />Fira ExmgMhtr ? <br />Garbage <br />Can <br />Names of responsible persons to be present in booth during all hours of operation: <br /><=h, < <zz> < ~~V~ C s <br />.....mportant** M 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 />tetoovSSt . — _ <br /> <br />Date <br />Ice Cooler