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10. <br />11. <br />OR <br />12. <br />|^i/Vater 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 />13. <br />‘‘Important** <br />Completed by:14. <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser | <br />CutiiiX) Board <br />Bleach <br />Propane Slove <br />I <br />Propane Tank <br />Bleach and Waler <br />Fire Extinguisher <br />J <br />TEMP EVENT APP <br />Extra <br />Waler <br />5 Gal Hand wasn <br />Wastewaler Container <br />6-20 Gal. <br />Hand wash Water <br />Sanitizer oucsei- <br />oleacn ft water to: <br />storing wiping dotns <br />Slorno w/Chatfing <br />Dish <br />Garbage <br />Can <br />■ j a copy of this application in <br />A copy of this checklist must be in the booth at all hours of <br />Soap and Waler <br />I <br />-- - ii <br />Ice Cooler I I _!----------------------------------- <br />Extra Ice Bags i Food Containers must be <br />stored 6 Inches oil ot lhe ground! <br />JU_z <br />Rinse Water <br />SAN J l) A Lili IN <br />-C OU NT Y <br />--------------------- - <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />E n v i iron me nta! i th De p a i-'S n-- e nt <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />@\Fhree compartment sink. <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 />j^Paper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation: <br />FRaJ) mdlltAx______ <br />All food vendor booths are subject to inspection. Please make <br />preparation for this event. >. __r, <br />preparation and operation. Return original to festival coordinator three weeks, prior to <br />thlS Cav) _________________3 - n <br />1 gignature Title Date <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />45OF (if food is used the following day, maintain below 41 °F temperature): <br /> Ice chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br />pother (specify)_____ tV*•El'Z.-l /S------------------------------------------------------------------------------------- <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd com <br />EHD 16-02 <br />07/3/17