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Environmental Health Department <br />10. <br />11. <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 />be present in booth during all hours of operation:13. <br />//Completed by: 14. <br />DateSignatun <br />IHealth Permit <br />Paper Hand Towels <br />Soap dispenser <br />BleachPropane Stove <br />Propane Tank <br />Bleach and Water <br />Fire Extinguisher <br /> fl <br />Ice Cooler <br />TEMP EVENT APP <br />t , .tl <br /> Refrigerated truck <br /> Other (specify) <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <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 />ll <br />7 <br />Rinse WaterSoap and Water <br />All food vendor booths are subject to inspection. Please make a copy of this application in <br />preparation for this event/ A cgpy-Qf tbjfe checklist must be in the booth at all hours of <br />preparation and operation. Returnofiqmal to festival coordinator three weeks ppior to <br />this ey^nt. <br />lM-yy I----1 I <br />“Important** <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 />®1ce chests Refrigerator <br />Ice bath and tubs <br />OR <br />PTThree deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for a bleach <br />ssblution (one tablespoon of bleach per gallon of water). <br />□^Detergent, bleach, and wiping cloths (cleaning towels). <br />ffil'T-ub to store wiping cloths in bleach solution. <br />^^aper towels and pump-style soap container. <br />Names oTrespo/lsible persons^® be prefei <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 ".'Em <br />07/3/17 <br />Extra Ice Bags & Food Containers must be <br />stored 6 inches off of the ground! 91 <br />T = <br />Title <br />Cutting Board