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f <br />Environmental Health Department <br />10 <br />11. <br />OR <br />12. <br />J/fWater supply dispenser with warm water at a minimum of 100T (i.e. 5-20 gallon container with spigot). <br /> One separate tub (bucket or basin) for the collection of rinse/wastewater. <br /> Paper towels and pump-style soap container. <br />13.Names of responsible persons to be present in booth during all hours of operation: <br />Completed by: -14. <br />Signature <br />8Health Permit <br />I Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />IBleachPropane Stove <br />■M■ ■ I <br />Bleacn and Water <br />Fire Extinguisher <br />Ice Cooler <br />$ <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 />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 410F temperature): <br /> Ice chests Refrigerator <br />ET^efrigerated truck Ice bath and tubs <br /> Other (specify)__ <br />5-20 Gal <br />Hand wash Water <br />SAN JOAQUIN <br />- COUNTY------ <br />** Im porta nt** <br />&(ra fee Sags & Food Conra/ners nvjsl be <br />stored 6 inches aft ol the ground1 <br />Title <br />______O Q -e. _______________________________________________ <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 />thissventz <br /> <br />'Date ' <br />Propane Tank <br />---------------------s <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />.Q^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 /> Detergent, bleach, and wiping cloths (cleaning towels). <br /> Tub to store wiping cloths in bleach solution. <br />1868 E Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd com <br />EHD 16-02 Page 8 of 11 TEMP EVENT APP <br />n7/-ii/i7