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Environmental Health Department <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 /> One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Q- Paper towels and pump-style soap container. <br />**lmportant** <br />OWNER > <br />14. <br />Title <br />Health Permit <br />I Paper Hand Towels <br />Soap dispenser <br />Culiirlfl Board <br />BleachPropane Stove <br />r~i u-■4 <br />Bleach end Water <br />Fire ExllnpulshorG <br />Ice Cooler <br />TEMP EVENT APP <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 />0 Tub to store wiping cloths in bleach solution. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Slerno w.Cliainng <br />Dish <br />Extra <br />Water <br />5 Gal Hand wash <br />Wastewater Conta'iier <br />5-20 Gal. <br />Hand wash Water <br />Garbage <br />Can <br />Sanlllzor bucket­ <br />bleach & waterier <br />storing wiping cloths <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Exira fce Bags & Food Contaiws must be <br />stored 6 Inches oil of Iho ground! <br />"h <br />10. <br />_z <br />Soap and Water Rinse Waler <br />Propane Tank <br />13. t0 be Present ln boo,h during al1 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 />preparatiorPand operation, zgr4 - ------*— ------------------------- *<' <br />this everif. <br />Completed by: <br />S sjgliatufey <br />Ip UB <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16-02 Pago 8 ol 11 TZM? ZVCMT <br />06/19/19 <br />teturn original to festival coordinator three weeks prior to <br />Date' <br />■'T SAN JOAQUIN <br /> ------COUNTY------ <br />‘ .,..•9 (>'/eri!rx>!.'. (jeows Ik'ih. <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 />0 Ice chests □Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify)