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<br />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 />O One sepa^te tub (bucket or basin) for foe coHecfion of rinse/wastewater. <br />Paper towels and pump-style soap container. <br />13. <br />Completed by:14. <br />Date <br />Slemo wfChaffing <br />Pap«r Hand'FowvU <br />SospcS^MAMr <br />Cutiptf Board <br />BieacnPropane Slov» <br />. 9oap and Water R>ue Water Water <br />Fira Extrjgtrahw <br />IceCooler <br />EHD 16-02 <br />07/3/17 <br />I am providing foe following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />Extra <br />Water <br />S-Gai Handwaah <br />Wattawaiar Container <br />I am providing the fotiowing for adequate hand washing facilities, but separate from utensil wash within my <br />booth- <br />WC Gai <br />Hand wash Watar <br />GartMtfiiB. <br />Can <br />Sarxhzarbucksl- <br />biaach & watar for <br />storing w ng ctoth* <br />TWe <br />| Extralo»B«^AFMiGMtaiN«nutf.b« <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 bteech per gaUon of water) <br /> Detergent, bleach, and. wiping cloths (cfeartng towels). <br />LJ Tub to store wiping cloths in bleach- solution. <br />| Health Permit p <br />SAHJOWfflN <br />------COUNTY------ <br />:-.e$5 grows hero. <br />pyidino the following cold temperature control for the cold holding of potentially hazardous foods below <br />(if food is used the following day, maintain below 41 °F temperature): <br />0 Ice chests Refrigerator <br />O Refrigerated truck ZW*® b^h and tubs <br /> Other (specify)_—------------------ <br />Bootti must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Names of responsible persons to be present in booth during all hours of operation: <br />ond lOxtM <br /> <br />^Important** AH food venctar 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 foe booth at alt hours of <br />preparation and dDeraftoft^R'efttm to festhral coordMator three weifcs prior to <br />— Lcxyr-^_________ <br />Signature <br />1868 E. Hazelton Avenue | Stockton, California 95205 ] T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />Psge Bern TEMP EVENT AFP <br />• x <br />10. I am <br />45