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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />13. <br />**lmportant* <br />Completed by:14.r Sig re <br />Paper Hand Towels <br />Soap dispenser <br />BleachPropane Stove <br />Bleach and Water <br />Fire Extinguisher <br />Ice Cooler <br />I <br />TEMP EVENT APP <br />/ <br />Rinse WaterSoap and Water <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 />Health Permit £ <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 />[$jjce chests Refrigerator <br /> Refrigerated truck Ice bath and tubs ; <br /> Other (specify)__ ___________________ <br />0| Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot) <br />C&One separate tub (bucket or basin) for the collection of rinse/wastewater <br />5-20 Gal <br />Hand wash Water <br />SAN JOAQUIN <br />COUNTY - <br />Exrra fee Bags & Food Containers must be C <br />stored 6 inches off of the ground! L <br />Ml <br />Propane Tank <br />P Paper towels and pump-style soap container. <br />Names of responsible persons to be jyesent in booth during all hours of operation: <br /> <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 ^nd opbration. Return original to festival coordinator three weeks prior to <br />this event. / // , s 2 _____ <br />Title 'Date <br />lam providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />j^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 />g Detergent, bleach, and wiping cloths (cleaning towels). <br />0 Tub to store wiping cloths in bleach solution. <br />1868 E Hazelton Avenue I Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />EHD 16-02 Page 8 or 11 --------