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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />-EiTWater supply dispenser with warm water at a minimum of 100 °F (i.e. 5-20 gallon container with spigot). <br />13. <br />14.Completed by: <br />Paper Mane' Tcwela <br />Soap dispenser <br />BteaehPropane Stove <br />PropaneTanJ: <br />Bleach and Witter <br />Fire EXkigursher <br />F2 <br />MWWC9*2±SS^ <br />0 <br />EHD 16-02 <br />07/3/17 <br />separate tub (bucket or basin) for the collection of rinse/wastewater. <br />0Paper towels and pump-style soap container. <br />Exira <br />Water <br />5 GeI Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />S-2Q Gal. <br />Hand wash Water <br />Sanitizer bucket­ <br />bleach a wafer for <br />storng wiping cfolhs <br />Slemo w/Chaffing <br />Dish <br />SAN JOAQUIN <br />COUNTY- ■ <br />tepresi <br />Rinse WaterSoap and Water <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />__________________2 <br />^Important1* <br />Health Permit fe <br />I am providing the foliovying for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Title S Date <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />FJ Three compartment sink. <br />-^fThree 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 />Q Detergent, bleach, and wiping cloths (cleaning towels). <br /> Tub to store wiping cloths in bleach solution. <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />45^ (if food is used the following day, maintain below 41 °F temperature): <br />Ice chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br />EJ Other (specify) _____________________________________ <br />..... <br />f Ice Cooler <br />tzOfH Ice Hags & rood Ccntaiwrs must be <br />zto.-v ci 6 inches off of the greend! <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.corn <br />-T- '■ - -2 Pag® 8 of 11 TEMP EVENT APP <br />Names of responsible persons to be present in booth during ail hours of operation: <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. Retur^-eregfeaHo-^stival coordinator three weeks prior to <br />this event ' —- —r— <br />Cutting Bossd