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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br /> Paper towels and pump-style soap container. <br />13. <br />Completed by: 14.DateTitleSignature <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />BleachPropane Stove <br />Propane Tank <br />Fire Extinguisher <br />TEMP EVENT APPPage 8 of 11 <br />I <br />J <br />Stem© w/Chaffing <br />Dish <br />Extra <br />Water <br />5 Gal Hand wash <br />Wastewater Container <br />5-20 Gal. <br />Hand wash Water <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />Extra Ice Bags & Food Containers must be <br />stored 6 inches off of the ground! | <br />— <br />_ <br />p3-$Vater supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br /> One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />Soap and Water Rinse Water <br />Ice Cooler i < <br />Names of responsible persons to b^present irijj^oth during^glHTOurs of operation. <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 EVEN! <br />07/3/17 <br />"Important” <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />----------------------Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <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 />this event. -z-. ■ i \ . ...__ <br />SAN JOAQUIN <br />------COUNTY------- <br />Greotnsss jrows 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 />Ice chests Refrigerator <br />/ 2] Refrigerated truck O Ice bath and tubs <br /> Other (specify)---------------------------------------------------------------------- ------------------------------ --------------------------- <br />Bleach and Water | <br />| Health Permit"1^ <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 />fcffiub to store wiping cloths in bleach solution. <br />Garbage <br />Can