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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />B3 Paper towels and pump-style soap container. <br />13. <br />Important** <br />14. <br />Health Permit <br />Paper Hand Towsn <br />Soap drepenscr <br />Cutting Boa'd <br />BleachPropane Stove <br />IS <br />Rinse Water Bleach and Water <br /> Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot), <br />ffi One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Extra tea Bags & Food Cantnna^ must be <br />sfored 6 inches oft oitha ground' <br />Slerno w/Cruffing <br />Dish <br />Exira <br />Water <br />Garbage <br />Can <br />Booth must be on <br />Concrete, Asphalt. <br />Plywood, ora Tarp. <br />SAN JOAQUIN <br />■...COUNTY....... <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />5 Gal Hand wash <br />Wastewater Container <br />« ■ SwW <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 Q Refrigerator <br /> Refrigerated truck ice bath and tubs <br /> Other (specify) ~ _________________ <br />Propane T ank <br />5-20 Gal <br />Hand wash Water <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Names of responsible persons to be present in booth during all hours of operation: <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />[J 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 />nU}(Vr <br />u Title <br />_L <br />Soap and Water <br />1868 E. Hazelton Avenue | Stockton. California 95205 | T 209 468-3420] F 209 464-0138 I wwwsjcehd.com <br />EHD 16-02 Page 8 of 11 TEMP EVENT APR <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 9 vent- <br />Completed by: WXwMwt (V C <br />Signature <br />I F’re Ex1<i0ui«ber <br />--- ------------------f .! <br />Ice Cooler i | <br />........M