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Environmental Health Department <br />11. <br />OR <br />12. <br />Draper towels and pump-style soap container. <br />13. <br />"Important** <br />Completed by: 14. <br />Signature <br />Paper Hand Towels <br />Soap dispenser <br />BleachPropane Stove <br />"x <br />])n <br />Bleach and WaterRinse Water <br />Eire Extinguisher <br />Ice Cooler <br />Page 8 of 11EHD 16-02 <br />(16/19/10 <br />Q^ater supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />H^One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />5 Gal Hand wash <br />Wastewater Container <br />5-20 Gal. <br />Hand wash Water <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Stemo w/Chaffing <br />Dish <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />Title <br />Health Permit <br />£ <br />Soap and Water <br />SAN JOAQUIN <br />------COUNTY------ <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 4TF temperature): <br />Qzlce chests Refrigerator <br /> Refrigerated truck O Ice bath and tubs <br /> Other (specify) <br />r~~ '- <br />Extra Ice Bags & Food Containers must be ; <br />stored 6 inches off of the ground! i I <br />lamproviding the following items within my booth for the sanitary cleaning of food preparation utensil <br />Q^^fhree compartment sink. <br />’Q/ifhree deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for a bleach <br />solution (one tablespodn of bleach per gallon of water). <br /> Detergent, bleach, and wiping cloths (cleaning towels). <br /> Tub to store wiping cloths in bleach solution. <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 />this event, , , <br /> <br />Date ' <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420] F 209 464-0138 | www.sjgov.org/ehd <br />-! - " Page 8 of 11 TEMP EVENT APP <br />Propane Tank <br />-------------------------J <br />J ...u <br />Garbage <br />Can <br />T <br />c ?- <br />10. <br />I Cutting Board <br />Names of responsible persons to be present in booth during all hours of operation: