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Environmental Health Departmentc: <br />10. <br />11. <br />OR <br />12. <br />0 Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />0 One separate tub (bucket or basin) for the collection of rlnse/wastewater. <br />0 Paper towels and pump-style soap container. <br />13. <br />Completed by:14. <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Culling Board <br />Bleach <br />Propan® Stove <br />1• / <br />Firo Extinguisher <br />TEMP EVENT APP <br />EidrB Ico Bags & Food Conlalners must bo ’ <br />stored 6 Inches ott of the ground I <br />Stemo w/Chaffing <br />Dish <br />5 Gal Hand wash <br />Waslewatar Container <br />5-20 Gal. <br />Hand wash Waler <br />Garbage <br />Can <br />Booth must be on <br />Concreto, Asphalt, <br />Plywood, or a Tarp. <br />Names of responsible persons to be present In booth during all hours of operation: <br />Josh Stremmel, Morgan Stremmel, Anthony Burnside .... <br />Exira <br />Water <br />Sanitizer buckol- <br />bleech A water for <br />storing wiping cloths <br />fl <br />owner/operator <br />Title <br />Propene Tank _z <br />Soap end Waler <br />— <br />—71 ! <br />Rinse Water <br />Ice Cooler <br />03-12-19 <br />Date <br />Important** <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />0 Three 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 />0 Detergent, bleach, and wiping cloths (cleaning towels). <br />0 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 />5 U 0 LzJ - <br />^L. <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420] F 209 464-0138 | www.sjcehd.com <br />I fcIVii EVCiN I <br />EHD 18-02 <br />07/3/17 <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 />Signature <br />SAN JOAQUIN <br />------COUNTY------- <br />(flI'tiHi'tss h-'ic. <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 /> Ice chests 0 Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify)^ ________________—---------------------------------------------—