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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />[XI Water supply dispenser with warm water at a minimum of 100cF (i.e. 5-20 gallon container with spigot) <br />13.■ation: r\ <br />14.Completed by: <br />Signature Title Date <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />BleachPropane Stove <br />Fl <br />Propane Tank <br />Bleach and WaterSoap and Water Rinse Water <br />EHD 16-02 <br />07/3/17 <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Extra Ice Bags & Food Containers must be <br />stored 6 inches off of the ground! <br />Sterno w/ChaffmgDish <br />Extra <br />Waler <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach & water for <br />stonng wiping cloths <br />Booth must be on <br />Concrete. Asphalt. <br />Plywood, or a Tarp <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 />r^Jce chests Refrigerator <br /> Refrigerated truck JK| Ice bath and tubs <br /> Other (specify) <br />^Jhree 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 />5-20 Gal <br />Hand wash Water <br />SAN JOAQUIN <br />COUNTY <br />-----—i—d <br />Ice Cooler <br />turn original to festival coordinator three weeks prior to <br />w&p 3 / <br />Titlp Datp ' <br />Fire Extinguisher <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420) F 209 464-0138 | www.sjcehd.com <br />Z:!D1CC2 Pages of 11 TEMP EVENT APR <br />K[One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Paper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation- <br />pflA/ , b£-V No/VT. ■ <br />rr~A _________________ <br />‘‘Important** All food vendor booths are subject to inspection. Please make a copy of this application in <br />preparation fgj_this event. A pepy~o\this checklist must be in the booth at all hours of <br />preparatioiy^nd operations <br />this event! /\