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Environmental Health Department <br />11. <br />OR <br />12. <br />'Onezseparate tub (bucket or basin) for the collection of rinse/wastewater. <br />laper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation: , <br /> <br />13. <br />Title | Date <br />Completed by: 14. <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />BleachCPropane Stove <br /> I A <br />Propane Tank <br />Rinse Water Bleach and WaterSoap and Water <br />Fire Extinguisher <br />Ice Cooler <br />Exfra Ice Bags & Food Containers must be <br />stored 6 inches off of the ground! <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 />5-20 Gal. <br />Hand wash Water <br />IS <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />bootp: <br />M Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />‘‘Important**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 even/ , I <br /> <br />Signature <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />□ Three compartment sink. <br />j^flTiree deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for a bleach <br />sohjffon (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 />" '' <br />10. <br />SANJOAOUIN <br />------COUNTY------- <br />Greatness grows here. <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 />E/ Ice chests O Refrigerator <br />□ Refrigerated truck O Ice bath and tubs <br />□ Other (specify) <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420] F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16-02 Page 8 of 11 TEMP EVENT APP <br />06/19/19