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I <br />Environmental Health Department <br />10. <br />11. <br />OR <br />1 <br />12. <br /> One separate tub (bucket or basin) for the collection of rinse/wastewater. <br /> Paper towels and pum de soap container. <br />13. <br />Completed by: 14. <br />Paps Ksrtd Towels <br />Precars- SZwe <br />Steals ttdWacr <br />X- <br />Health Permit <br />5 GM Mart wash <br />Wmewster CcnMw <br />Garbage <br />Can <br /> Booth must be on <br />Concrete, Asphalt <br />Plywood, or a Tarp. <br />Exin 10 Bogs £ Food CBrtfaners ntisi be <br />^ored € tacfws off cd £k gmmff <br />budtef- <br />DiK>^ & V^tcr for <br />sattog vising <br />Stsnow'OtaSnG <br />OW-- <br />Ice Cooler ' <i > <br />_ L- <br />SAN JOAQUIN <br />------COUN’Y------- <br />S^O GJ. <br />HarttfwMhWsttt <br />( t <br />I Wstsr | <br /> <br />_z <br />Soeo end Waiar <br />J B <br />RjtW Water <br />I Cutting Soard <br />Names of <br />••Important** <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />H Water supply dispenser with warm water at a minimum of 100CF (i.e. 5-20 gallon container with spigot). <br />responsible pe^o^s present *n booth during all hours of operation: <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 /> <br />Signature Title Date <br />•:. 5' • • ’ * " ’ <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 foilowing day. maintain below 41 °F temperature): <br /> Ice chests Refrigerator <br />o Refrigerated truck . Ice bath and tubs <br /> Other (specify)A/ M z - - ___ <br />1 am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br /> T^ree 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 />Q 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 209 468-34201 F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16-02 PsgsSolll TEMP EVENT APP <br /><xn^m <br />PrwancTanft <br />_______J <br />9