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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />O^Water supply dispenser with warm water at a minimum of 100cF (i.e. 5-20 gallon container with spigot) <br /> One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />QJ’f’aper towels and pump-style soap container. <br />13.Names of responsible persons to be present in booth during all hours of operation: <br />14.Completed byr <br />Signature <br />[ <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />BleachPropane Stove <br />iT <br />. -. ..... <br />Rinse Water Bleach and Water <br />Fire Extinguisher <br />___________ <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Sterno w/Chaffing <br />Dish <br />Extra <br />Water <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />5-20 Gal. <br />Hand wash Water <br />-<P' <br />; in <br />Q <br />Ice Cooler <br />___________/ <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />B^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 />EzTub to store wiping cloths in bleach solution. <br />I <br />**lmportant** <br />Soap and Water <br />] <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. Returt) original to festival coordinator three weeks prior to <br />this event. /7 7 ’i <br />—c T <f <br />Title <br />SAN -JOAQUIN <br />------COUNTY------- <br />Greatness grows here. <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />4ST (if food is used the following day, maintain below 41°F temperature): <br />Ice chests Refrigerator <br /> Refrigerated truck Ice 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 8 of 11 TEMP EVENT APP <br />06/19/19 <br />Propane Tank <br />------------------------J <br />Extra Ice Bags & Food Containers must be I ? <br />stored 6 inches off of the ground! “ 0 <br />Health Permit |i <br />H ::