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SAN JOAQUIN 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 /> One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />13. <br />••Important** <br />14.Completed by: <br />Signature <br />Health Permit <br />Papar Hood Towata <br />Soapdtapanaar <br />BlaachPropane 8tova <br />IE <br />Propane Tank <br />Rtnae Walar <br />Ice Cooler <br />Saritzerbuctcet- <br />Ueecri&waler for <br />storing «tfpiriQ ctoths <br />Extn fae Bag* A Food Oontaintn mutt to <br />ttond 8 Mtec oKoftho gnwndt <br />Stomp wICheMng <br />Dteti <br />Extra <br />Water <br />5Gal Hand wart <br />Waatoaator Container <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <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 /> Refrigerated truck Ice bath and tubs <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 />Garbage <br />Can <br />Booth must be or <br />Concrete, Asphalt <br />Plywood, ora Taq <br />5-20 Gto. <br />Hand wMh Water <br />Title <br />Names of responsible persons to be present in booth during ali hours of operation: <br /> _________________ <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 j F 209 464-0138 j www.sjgov.org/ehd <br />EHD1M2 Page 8 of 11 TEMP EVENT APP <br />M/lfVIfl <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 orfainil to feativil coordinator throe weeks prior to <br />this event » <br />_______________ _________________ <br />' Date <br />I <br />Soap and Water <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 /> Tub to store wiping cloths in bleach solution. <br />J Are ExUnottahar