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Environmental Health Department <br />10. <br />-Iding the following items within my booth for the sanitary cleaning of food preparation utensil <br />12. <br />Names of n13. <br />Completed by:14.DateTitle <br />Paper Hand Towelt <br />Cutting Board <br />Propane Steve <br />WSI <br />Propane Tank <br />Bleach and WaterRinse Water <br />Fire Extinguisher <br />I <br />TEMP EVENT APP <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />Stemo w/Chaffing <br />Dish <br />5-20 Gal. <br />Hand washWater <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />SAN JOAOUIN <br />COUNTV <br />( Extra ' <br />I Waler <br />Extra Ice Bags & Food Containers must bo <br />stored G inches off of the ground! ?. <br />___[ <br />Soap and Water <br />11. lam providing the following i <br />® Three compartment sink. <br />OR <br />**lm portant** <br />( , i ■;< i Hi < s ■■ •; i ;i V. •• 1 •' <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 />0 Ice chests S Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify)_ ________—----------------------------- <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 poor to <br />this event.,/HL — <br />Signature <br /> 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 /> Detergent, bleach, and wiping cloths (cleaning towels). <br /> 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 />•0 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 />Soap dispenser ----------- \ <br />I <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420] F 209 464-0138 | w^.sjcehd.com <br />EHD 16-02 <br />07/3/17 <br />f ~ j <br />Health Permit § <br /> Paper towels and pump-style soap container. <br />;;' responsible persons to be present in booth during all hours of operation: <br />lei ___________________________ <br />Ice Cooler