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■■■HI <br />SANJOAQUIN Environmental Health Department <br />10 <br />11 <br />OR <br />12 <br />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 />'S- Paper towels and pump-style soap container. <br />13. <br />14 Completed by: <br />Health Permit <br />Paper Hard Toweis <br />Soap dispenser <br />Cuttnr) Board <br />1 BleachPropane Sto*e <br />0 <br />Prop*'* T»n» <br />) <br />Fire Eltrngursher <br />Ice Cooler <br />TEMP EVENTAPP <br />Extra <br />Water <br />5 Gal Hand wosn <br />Wastewater Container <br />5-20 Gal <br />Hand wash Water <br />Garbage <br />Can <br />Sanituer bucket <br />bleach i water hx <br />Storing w<p.ng cloths <br />Booth must be on <br />Concrete. Asphalt <br />Plywood, or a Tarp <br />I am providing the following cold lompoiahire control for the cold holding of potentially hazardous foods below <br />45'F (if food is used the following day, maintain below 4t"F temperature) <br />Ice chests <br />F' Refrigerated truck <br />[S Other (specify) <br />Sterno wfChatfing <br />Dish <br />IQ/7M <br />Date <br />|_>f Refiigeialot <br />F ] Ice bath and tubs <br />Rinse Water <br />esent in booth during all hours of operation: <br /> rVXn-fM \kjvU _____________________ <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 evept. . <br /> <br />Signature'' Title <br />tarn providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />PS Three compartment sink <br />L_ 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 waler). <br />T Detergent, bleach, and wiping cloths (cleaning towels). <br />O Tub to store wiping cloths in bleach solution <br />__1 <br />and Wat« <br />providing the following foi adequate hand washing facilities, but separate from utensil wash within my <br />l. tho Iv Hoyt i Food ContainefS must bt> M <br />sfezefl 0 mrjMis <Jt <j! tho ground1 <br />1868 E Hazelton Avenue | Stockton, California 95205 | T 209 468-3420) F 209 464-0138 | www.sjgov orq/ehd <br />ow'zoftf Page 8 of 11 TEMP EVENT A> <br />Names of responsible persojis to be present in booth aunng all hours of <br />‘’Important**